MEDICARE: ALLISON FULLER

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1558133249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON FULLER

Provider Business Mailing Address
First Line	:	3611 31ST AVE APT 1H
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11106-1081
Country	:	US
Telephone Number	:	719-271-3569
Fax Number	:

Provider Business Practice Location Address
First Line	:	3611 31ST AVE APT 1H
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11106-1081
Country	:	US
Telephone Number	:	719-271-3569
Fax Number	:

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

Provider Enumeration Date	:	10/25/2023
Last Update Date	:	03/02/2026

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Directions to “ ALLISON FULLER ” Practice Location

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