Provider Demographics
NPI:1053681874
Name:FULLMER, AARON MICHAEL (LMFT)
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:MICHAEL
Last Name:FULLMER
Suffix:
Gender:M
Credentials:LMFT
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 4726
Mailing Address - Street 2:
Mailing Address - City:LAGO VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:78645-0008
Mailing Address - Country:US
Mailing Address - Phone:512-797-6861
Mailing Address - Fax:
Practice Address - Street 1:8006 AUTUMN MOOR BND
Practice Address - Street 2:
Practice Address - City:LAGO VISTA
Practice Address - State:TX
Practice Address - Zip Code:78645-2069
Practice Address - Country:US
Practice Address - Phone:512-797-6861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203830106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist