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NPI Code Detail

MEDICARE: MALLORY FULLER M.A.

MEDICARE: MALLORY FULLER M.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorMH25058FL

General Provider Information

NPI Number : 1346016698
Entity Type Code : Individual
Provider Name (Legal Business Name) : MALLORY FULLER M.A.
Provider Business Mailing Address
First Line : 4686 SUNBEAM RD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32257-6189
Country : US
Telephone Number : 904-302-5340
Fax Number :
Provider Business Practice Location Address
First Line : 4686 SUNBEAM RD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32257-6189
Country : US
Telephone Number : 904-302-5340
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2023
Last Update Date : 06/10/2026

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Directions to “ MALLORY FULLER M.A.” Practice Location

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