Provider Demographics
NPI:1154520120
Name:FULLER, LYNNETTE YVETTE (LMHC)
Entity type:Individual
Prefix:MS
First Name:LYNNETTE
Middle Name:YVETTE
Last Name:FULLER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9010 SW 137TH AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1413
Mailing Address - Country:US
Mailing Address - Phone:305-385-0066
Mailing Address - Fax:305-385-0106
Practice Address - Street 1:9010 SW 137TH AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1413
Practice Address - Country:US
Practice Address - Phone:305-385-0066
Practice Address - Fax:305-385-0106
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2010-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6550101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health