Basic Information
| Provider Information | |||||||||
| NPI: | 1437415189 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FULLER | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | ALLEN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LMHP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2515 181ST AVE NE | ||||||||
| Address2: | |||||||||
| City: | REDMOND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980525940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258028316 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4240 AUBURN WAY N | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980021311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538768900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2012 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LH60426222 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.