1154520120 NPI number — MS. LYNNETTE YVETTE FULLER LMHC

Table of content: MS. LYNNETTE YVETTE FULLER LMHC (NPI 1154520120)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154520120 NPI number — MS. LYNNETTE YVETTE FULLER LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FULLER
Provider First Name:
LYNNETTE
Provider Middle Name:
YVETTE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154520120
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9010 SW 137TH AVE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33186-1413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-385-0066
Provider Business Mailing Address Fax Number:
305-385-0106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9010 SW 137TH AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33186-1413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-385-0066
Provider Business Practice Location Address Fax Number:
305-385-0106
Provider Enumeration Date:
07/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH6550 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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