Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1225495690 |
---|---|
Provider Name | Sandra Fuller |
First Address | Huffman, TX 77336-2877 |
Second Address | Humble, TX 77346-2343 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2016 |
Last Update Date | 15/01/2016 |