Full Life Outreach Medical Center LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

801062647 Issued in TX

Legal business name

FULL LIFE OUTREACH MEDICAL CENTER LLC

Practice address

4545 S Buckner Blvd
Dallas, TX 75227-4207

Phone

(214) 791-2863

NPI assigned

Aug 24, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Reginald Benjamin

Title

President

Phone

(214) 791-2863

Specialties & licenses 1

Addresses

Other names 1

• Full Life Outreach Center Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Richard Lee Benjamin

  • Peritoneal Dialysis Registered Nurse
  • Dallas, TX
  • NPI 1245197292
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1251072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765756800000",
    "number": "1265665384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4545 S BUCKNER BLVD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752274207",
            "telephone_number": "214-791-2863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4545 S BUCKNER BLVD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752274207",
            "telephone_number": "214-791-2863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULL LIFE OUTREACH MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-24",
        "last_updated": "2025-12-15",
        "certification_date": "2025-12-15",
        "status": "A",
        "authorized_official_last_name": "BENJAMIN",
        "authorized_official_first_name": "REGINALD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "214-791-2863",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "801062647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Full Life Outreach Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stephanie Fulgencio, LMFT
• Angela K Fulgham-Gardner, MD
• Pat Fox Fulgham, M.D.
• Dawn Maria Fulghum, LPTA
• Full Circle Counseling and Family Services, PLLC
• Aileen Fullchange, LP
• Andrea Nicole Fuller, PA-C
• Dale Eugene Fuller, MD
• Dana A Fuller, MD
• Deborah A Fuller, M.D.

• Clinical Social Worker in Dallas, TX
• Providers in Dallas, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.