Provider Demographics
NPI:1497807937
Name:FULLER, GAYLE LYNN (MED, LPC)
Entity type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:LYNN
Last Name:FULLER
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3007 DILLON WOOD CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-4689
Mailing Address - Country:US
Mailing Address - Phone:713-397-2778
Mailing Address - Fax:281-578-8546
Practice Address - Street 1:16100 CAIRNWAY DR
Practice Address - Street 2:SUITE 205
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-3562
Practice Address - Country:US
Practice Address - Phone:713-397-2778
Practice Address - Fax:281-578-8546
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16543101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health