Provider Demographics
NPI:1205966546
Name:FULLER, ALEXANDER D (MA, LPC)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:D
Last Name:FULLER
Suffix:
Gender:
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 1:824 PINE ST STE 106
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1836
Mailing Address - Country:US
Mailing Address - Phone:720-352-3594
Mailing Address - Fax:
Practice Address - Street 1:824 PINE ST STE 106
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1836
Practice Address - Country:US
Practice Address - Phone:720-352-3594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO084-520493OtherEMPLOYER IDENTIFICATION