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General NPI Number Information
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NPI Number | 1760029961
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Entity Type | Organization
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Legal Business Name | FULLER NEUROPSYCHOLOGY
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Dates
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Enumeration Date | 12/06/2019
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Last Update Date | 12/06/2019
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Provider Practice Location Address
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Address Line | 2301 OHIO DR STE 130
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City | PLANO
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State | TX
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Zip | 75093-3997
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Country | US
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Telephone | 817-239-2744
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Fax |
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Provider Business Mailing Address
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Address Line | 7032 SOUTHRIDGE DR
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City | DALLAS
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State | TX
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Zip | 75214-3248
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Country | US
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Telephone | 817-239-2744
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | LAUREN FULLER
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Credential |
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Telephone | 817-239-2744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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