Provider Demographics
NPI:1851641278
Name:FULLER, CHRISTINE MARIE (MA, BCBA, LBA)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:MARIE
Last Name:FULLER
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 VASSAR ST
Mailing Address - Street 2:STE. 3
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3453
Mailing Address - Country:US
Mailing Address - Phone:775-448-6533
Mailing Address - Fax:775-787-2751
Practice Address - Street 1:2440 VASSAR ST
Practice Address - Street 2:STE. 3
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3453
Practice Address - Country:US
Practice Address - Phone:775-448-6533
Practice Address - Fax:775-787-2751
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
BCBA 1-12-11806103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst