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1093964041
NATHAN JAMES FULLMER
IDAHO FALLS, ID
NPI
1093964041
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YM0800X Counselor, Mental Health
(Licence: ID LPC-3902)
Enumeration Date
2008-09-15
Last Update Date
2023-06-08
Business Address
NATHAN JAMES FULLMER LPC
685 1ST ST
IDAHO FALLS, ID 83401-4003
Phone number: 208-228-7043
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Mailing Address
NATHAN JAMES FULLMER LPC
685 1ST ST
IDAHO FALLS, ID 83401-4003
Phone number: 208-228-7043
Copy
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