Doctor Name: | JESSICA FULLER |
NPI Number: | 1003209289 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 4005 |
Business Practice Address: | 5005 N Piedras St Wbamc El Paso, TX - 799205002 |
Business Phone Number: | 9157422973 |
Business Fax Number: | |
Mailing Address: | 5005 N Piedras St, Wbamc EL PASO |
State: | TX |
Postal Code: | 799205002 |
Phone Number: | 9157422973 |
Fax Number: | |
NPI Enumeration Date: | 03/11/2015 |
NPI Last Update Date: | 03/11/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 4005 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | HI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |