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General NPI Number Information
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NPI Number | 1851240709
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Entity Type | Organization
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Legal Business Name | ERIC FULLEN LLC
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Dates
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Enumeration Date | 01/23/2026
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Last Update Date | 01/23/2026
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Provider Practice Location Address
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Address Line | 393 GARDEN AVE
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City | HOLLAND
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State | MI
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Zip | 49424-9602
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Country | US
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Telephone | 616-287-5966
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Fax |
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Provider Business Mailing Address
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Address Line | 393 GARDEN AVE
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City | HOLLAND
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State | MI
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Zip | 49424-9602
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Country | US
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Telephone | 616-287-5966
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | ERIC FULLEN
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Credential |
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Telephone | 612-817-3371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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