Fuller, Brian

Fuller, Brian is an individual health care provider with primary practice located at 500 Willow Ave Suite 305, Council Bluffs IA 51503-0827. He recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as his primary health care specialty. Fuller, Brian can be contacted via phone (712) 256-4420.

Contact Information

Primary practice address
500 Willow Ave Suite 305 Council Bluffs IA 51503-0827
Phone: (712) 256-4420
Fax: (712) 256-4423
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 1978 Nebraska

Profile Details

NPI number 1659576841
LBN Legal business name Fuller, Brian
Credentials MS, LMSW, LMHP
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 18th, 2007
Last updated Jun 19th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1659576841 NPPES
Iowa MEDICAID 1010744
Iowa MEDICAID 100253517-00

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