Provider Demographics
NPI:1497100473
Name:FULLER, LORIE A (MA, LPC)
Entity Type:Individual
Prefix:
First Name:LORIE
Middle Name:A
Last Name:FULLER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 N MAIN ST STE I
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2450
Mailing Address - Country:US
Mailing Address - Phone:970-901-0937
Mailing Address - Fax:970-641-4224
Practice Address - Street 1:307 N MAIN ST STE I
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2450
Practice Address - Country:US
Practice Address - Phone:970-901-0937
Practice Address - Fax:970-641-4224
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC0104462101YM0800X
CO0014857101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health