Provider Demographics
NPI:1609203413
Name:C.H. FULLER & ASSOCIATES LLC
Entity Type:Organization
Organization Name:C.H. FULLER & ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, LPC, LMFT
Authorized Official - Phone:210-970-1511
Mailing Address - Street 1:12951 HUEBNER RD STE 781466
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-9998
Mailing Address - Country:US
Mailing Address - Phone:210-970-1511
Mailing Address - Fax:
Practice Address - Street 1:12951 HUEBNER RD STE 781466
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-9998
Practice Address - Country:US
Practice Address - Phone:210-970-1511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-11
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9189101YP2500X
TX2991041C0700X
TX1081106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty