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JOHN PATRICK FULLAM LPC

Mental Health >> Counselor >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1720680945

Individual Registrant:
 JOHN PATRICK FULLAM LPC
Gender: M
Sole Proprietor

Location and contact information for practice:
725 MAIN ST  CARBONDALE, CO 81623-1936 US
Tel: 973-714-3036  Fax: --

Contact information for business:
811 MAIN CT  CARBONDALE, CO 81623-1851 US
Tel: 973-714-3036  Fax: --

Registration Information:
NPI: 1720680945
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y101YM0800XBehavioral Health & Social Service Providers
Counselor
Mental Health
COLPC.0016660

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
STATE LICENSELPC.0016660CO01




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