Provider Demographics
NPI:1336332642
Name:MATHESON FULLER, DEANNE MELOR (LCSW, MSW)
Entity Type:Individual
Prefix:
First Name:DEANNE
Middle Name:MELOR
Last Name:MATHESON FULLER
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 RESERVATION DR
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-7466
Mailing Address - Country:US
Mailing Address - Phone:254-690-1283
Mailing Address - Fax:
Practice Address - Street 1:415 RESERVATION DR
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-7466
Practice Address - Country:US
Practice Address - Phone:254-690-1283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX404181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical