Individual provider · Type 1 NPI

Ryan Austin Fullmer

Mental Health Counselor · Portland, OR

NPI number 1750954442 Active

Practice location

12505 SE Raymond St
Portland, OR 97236-3931

Call (503) 760-8300 Map

Fax (503) 760-8308

Mailing address

3587 Heathrow Way
Medford, OR 97504-4004

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XNone listed

Mental Health Counselor: Definition to come...

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About NPI 1750954442

Ryan Austin Fullmer's National Provider Identifier is 1750954442, issued on Jul 20, 2021. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Portland, OR. The record was last updated on Jul 20, 2021.