Provider Information for 1053681874
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Mr. AARON MICHAEL FULLMER LMFT
Sex: Male
NPI: 1053681874
Last Updated: 2023-01-23
Certification Date: 2020-10-08
Certification Date: 2020-10-08
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1053681874 | ||||||||
| Enumeration Date | 2012-01-10 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 4726 LAGO VISTA, TX 78645-0008 United States Phone: 512-797-6861 | Fax: | ||||||||
| Primary Practice Address | 8006 AUTUMN MOOR BND LAGO VISTA, TX 78645-2069 United States Phone: 512-797-6861 | Fax: | ||||||||
| Secondary Practice Address(es) | 201 S LAKELINE BLVD | ||||||||
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