Provider Demographics
NPI:1659822401
Name:PAMELA FULLER, MA, PSYCHOTHERAPIST, PLLC
Entity Type:Organization
Organization Name:PAMELA FULLER, MA, PSYCHOTHERAPIST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-920-6843
Mailing Address - Street 1:1329 LINCOLN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-6279
Mailing Address - Country:US
Mailing Address - Phone:360-788-4517
Mailing Address - Fax:360-647-6719
Practice Address - Street 1:1329 LINCOLN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-6279
Practice Address - Country:US
Practice Address - Phone:360-788-4517
Practice Address - Fax:360-647-6719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00000871106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty