Samuel Fuller
Social Worker, Clinical in Salt Lake City, UT. Individual provider (NPI-1).
NPI number1982157194
StatusActive
Last updated in NPPESJul 30, 2025
Details
- NPI
- 1982157194
- Entity type
- Individual (NPI-1)
- Name
- Samuel Fuller
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 25, 2016
- Certification date
- Jul 30, 2025
- Last updated
- Jul 30, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | 12920621-3501 | UT | Yes |
| 104100000X | Social Worker | – | – |
Practice location
3440 S 500 E Apt 88Salt Lake City, UT 84106-1280
Phone 801-773-7060
Mailing address
3440 S 500 E Apt 88Salt Lake City, UT 84106-1280
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