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JOHN PATRICK FULLAM LPC
Mental Health >> Counselor >> Behavioral Health & Social Service ProvidersRegistrant NPI Number: 1720680945
Individual Registrant: JOHN PATRICK FULLAM LPC
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
725 MAIN ST CARBONDALE, CO 81623-1936 US
Tel: 973-714-3036 Fax: --
Tel: 973-714-3036 Fax: --
Contact information for business:
811 MAIN CT CARBONDALE, CO 81623-1851 US
Tel: 973-714-3036 Fax: --
Tel: 973-714-3036 Fax: --
Registration Information:
NPI: 1720680945
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 101YM0800X | Behavioral Health & Social Service Providers Counselor Mental Health | CO | LPC.0016660 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| STATE LICENSE | LPC.0016660 | CO | 01 |
