Fuller Life Institute | |
4545 Bissonnet St Ste 289 Bellaire TX 77401-3112 | |
(855) 245-5433 | |
(855) 245-5433 |
Full Name | Fuller Life Institute |
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Speciality | Marriage & Family Therapist |
Location | 4545 Bissonnet St Ste 289, Bellaire, Texas |
Authorized Official Name and Position | Amy Fuller (CLINICAL DIRECTOR) |
Authorized Official Contact | 8552455433 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Fuller Life Institute 4545 Bissonnet St Ste 289 Bellaire TX 77401-3112 Ph: (855) 245-5433 | Fuller Life Institute 4545 Bissonnet St Ste 289 Bellaire TX 77401-3112 Ph: (855) 245-5433 |
NPI Number | 1316203029 |
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Provider Enumeration Date | 04/06/2012 |
Last Update Date | 04/06/2012 |
Medicare PECOS PAC ID | 9234666884 |
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Medicare Enrollment ID | O20241220002709 |
Identifier | Type | State | Issuer |
---|---|---|---|
1316203029 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
106H00000X | Marriage & Family Therapist | 201031 (Texas) | Primary |
Provider Name | Chantail Banks Green |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1851018048 PECOS PAC ID: 6507205762 Enrollment ID: I20240419003280 |
Provider Name | Dormetra Ann Henry |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1558079681 PECOS PAC ID: 4587006333 Enrollment ID: I20240523004019 |
Provider Name | Amy M Fuller |
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Provider Type | Practitioner - Marriage And Family Therapist |
Provider Identifiers | NPI Number: 1184730756 PECOS PAC ID: 2961939517 Enrollment ID: I20241220003018 |
Provider Name | Riya Roney Vettickal |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1417725417 PECOS PAC ID: 8820525272 Enrollment ID: I20241224000046 |
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