MEDICARE: VALERIA 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	101YP2500X	Professional Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1578324307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIA FULLER

Provider Business Mailing Address
First Line	:	28427 SUNRISE VIEW DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77386-4939
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	28427 SUNRISE VIEW DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77386-4939
Country	:	US
Telephone Number	:	832-577-5121
Fax Number	:

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

Provider Enumeration Date	:	01/18/2024
Last Update Date	:	01/18/2024

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Directions to “ VALERIA FULLER ” Practice Location

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