| Fuller Life Institute | |
|
4545 Bissonnet St Ste 289 Bellaire TX 77401-3112 | |
| (855) 245-5433 | |
| (855) 245-5433 |
| Full Name | Fuller Life Institute |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 04/06/2012 |
| Last Update Date | 04/06/2012 |
| Medicare PECOS PAC ID | 9234666884 |
|---|---|
| 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 |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1851018048 PECOS PAC ID: 6507205762 Enrollment ID: I20240419003280 |
| Provider Name | Dormetra Ann Henry |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1558079681 PECOS PAC ID: 4587006333 Enrollment ID: I20240523004019 |
| Provider Name | Amy M Fuller |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1184730756 PECOS PAC ID: 2961939517 Enrollment ID: I20241220003018 |
| Provider Name | Riya Roney Vettickal |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1417725417 PECOS PAC ID: 8820525272 Enrollment ID: I20241224000046 |
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