MR. Brian Jay Fuller, PH.D.

NPI #1942258595 in Portage, Michigan

Provider Information

NPI Number: 1942258595
Entity Type: Individual
Name: MR. Brian Jay Fuller, PH.D.
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Psychologist
Credential: PH.D.
Enumeration Date: May 5, 2006
Last Updated: Jun 19, 2012

Practice Location

Address: 1662 E CENTRE AVE
City: Portage
State: Michigan
ZIP Code: 49002-4410
Phone: (269) 321-8564

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist	103T00000X	Primary

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