Provider Demographics
NPI:1063848588
Name:FULLER, LAUREN E (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:E
Last Name:FULLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 OHIO DR STE 130
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3997
Mailing Address - Country:US
Mailing Address - Phone:972-612-1305
Mailing Address - Fax:972-867-3402
Practice Address - Street 1:2301 OHIO DR STE 130
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3997
Practice Address - Country:US
Practice Address - Phone:972-612-1305
Practice Address - Fax:972-867-3402
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling