Provider Demographics
NPI:1487316220
Name:FULLER, TATUM VANMETER (RBT)
Entity type:Individual
Prefix:
First Name:TATUM
Middle Name:VANMETER
Last Name:FULLER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:TATUM
Other - Middle Name:JANE
Other - Last Name:VANMETER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 W SW LOOP 323
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-9416
Mailing Address - Country:US
Mailing Address - Phone:430-205-8710
Mailing Address - Fax:
Practice Address - Street 1:1001 W SW LOOP 323
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-9416
Practice Address - Country:US
Practice Address - Phone:430-205-8710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-21-9458-348425106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician