| Organization Name: | FULLER THEOLOGICAL SEMINARY |
| NPI Number: | 1013126036 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | THEOPOLIS COSSE (EXECUTIVE DIRECTOR) |
| Mailing Address: | 180 North Oakland Avenue Pasadena |
| State: | CA US |
| Postal Code: | 911011714 |
| Phone Number: | 6265845555 |
| Fax Number: | 6265845558 |
| NPI Enumeration Date: | 05/22/2007 |
| NPI Last Update Date: | 12/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |