Provider Demographics
NPI:1700059664
Name:FULLMER, MARI ELIZABETH (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:MARI
Middle Name:ELIZABETH
Last Name:FULLMER
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 STATE ST, SUITE 204
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-7071
Mailing Address - Country:US
Mailing Address - Phone:805-886-5707
Mailing Address - Fax:
Practice Address - Street 1:629 STATE STREET, SUITE 204
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101
Practice Address - Country:US
Practice Address - Phone:805-962-2963
Practice Address - Fax:805-962-2965
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83237106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist