Provider Demographics
NPI:1720844939
Name:FULLER, NATASHA LACHINE (MBA, QMHP-CS)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:LACHINE
Last Name:FULLER
Suffix:
Gender:F
Credentials:MBA, QMHP-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 BALCONES DR STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4298
Mailing Address - Country:US
Mailing Address - Phone:682-277-9994
Mailing Address - Fax:
Practice Address - Street 1:6873 CHICKERING RD APT 116
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-9150
Practice Address - Country:US
Practice Address - Phone:682-277-9994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker