Provider Demographics
NPI:1689065617
Name:THE FULL FRUIT MINISTRIES,INC
Entity Type:Organization
Organization Name:THE FULL FRUIT MINISTRIES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DELORA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC,LCDC
Authorized Official - Phone:817-350-1510
Mailing Address - Street 1:500 ROLLING HILLS PL APT 1705
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-1036
Mailing Address - Country:US
Mailing Address - Phone:817-350-1510
Mailing Address - Fax:
Practice Address - Street 1:500 ROLLING HILLS PLACE #1705
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-1036
Practice Address - Country:US
Practice Address - Phone:817-350-1510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69477101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty