MEDICARE: JENNIFER FULLER LMFT

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
1	106H00000X	Marriage & Family Therapist	0730000384	VA
2	106H00000X	Marriage & Family Therapist	0717002505	VA
3	106H00000X	Marriage & Family Therapist
4	106H00000X	Marriage & Family Therapist	0730000384

General Provider Information

NPI Number	:	1538637095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER FULLER LMFT

Provider Business Mailing Address
First Line	:	8221 WILLOW OAKS CORPORATE DR
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-4512
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8221 WILLOW OAKS CORPORATE DR
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-4512
Country	:	US
Telephone Number	:	703-559-3000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2018
Last Update Date	:	03/13/2026

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