Provider Demographics
NPI:1336867670
Name:FULLER, LISA (LPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FULLER
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:BURLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:910 W ARCH AVE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-5212
Mailing Address - Country:US
Mailing Address - Phone:501-281-5137
Mailing Address - Fax:877-310-6350
Practice Address - Street 1:1507 E RACE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4661
Practice Address - Country:US
Practice Address - Phone:501-305-2359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2206021101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor