Provider Demographics
NPI:1013555739
Name:FULLER, JUNE WILLIAMS
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:WILLIAMS
Last Name:FULLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2063
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77347-2063
Mailing Address - Country:US
Mailing Address - Phone:832-264-5293
Mailing Address - Fax:
Practice Address - Street 1:15703 CAIRNWELL BEND DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-4361
Practice Address - Country:US
Practice Address - Phone:832-264-5293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-12
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TX6702511744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health