MEDICARE: BARBARA JO FULLER MS

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790091346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA JO FULLER MS

Provider Business Mailing Address
First Line	:	7151 MAILLER ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-8861
Country	:	US
Telephone Number	:	407-716-7668
Fax Number	:

Provider Business Practice Location Address
First Line	:	1350 N ORANGE AVE
Second Line	:	SUITE 223
City	:	WINTER PARK
State	:	FL
Zip	:	32789-4945
Country	:	US
Telephone Number	:	407-644-4367
Fax Number	:

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

Provider Enumeration Date	:	08/20/2010
Last Update Date	:	08/20/2010

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