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General NPI Number Information
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NPI Number | 1811395411
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Entity Type | Individual
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Provider Name | ANGELA FULLER MS, CPC-I
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Gender | Female
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Dates
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Enumeration Date | 12/12/2014
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 850 MILL ST STE 100
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City | RENO
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State | NV
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Zip | 89502-1463
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Country | US
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Telephone | 775-538-6700
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Fax |
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Provider Business Mailing Address
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Address Line | 1041 WARWICK AVE
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City | FALLON
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State | NV
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Zip | 89406-3662
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Country | US
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Telephone | 801-875-3055
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CI0284
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License Number State | NV
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