Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist |
NPI | 1063848588 |
---|---|
Provider Name | Dr. Lauren E Fuller |
First Address | Plano, TX 75093-3997 |
Second Address | Plano, TX 75093-3997 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2013 |
Last Update Date | 08/12/2016 |