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FULLER DIAGNOSTICS, LLC

Clinical Neuropsychologist

Anchorage, Alaska

Provider NPI: 1326152711

Organization Information:
Organization Name:  FULLER DIAGNOSTICS, LLC
Organization is not Subpart
Authorized Official:  KRISTI H FULLER  OWNER/PARTNER  907-5610552

Practice Location:
2600 DENALI ST SUITE 450 ANCHORAGE, AK 99503 US
Tel: 907-561-0552  Fax: 907-561-0562

Business Mailing Address:
PO BOX 92303  ANCHORAGE, AK 99509 US
Tel: 907-561-0552  Fax: 907-561-0562

Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N1041C0700XBehavioral Health & Social Service Providers
Social Worker
Clinical
AK1022
N1041C0700XBehavioral Health & Social Service Providers
Social Worker
AK1023
N103TB0200XBehavioral Health & Social Service Providers
Psychologist
N103TC0700XBehavioral Health & Social Service Providers
Psychologist
N103TC2200XBehavioral Health & Social Service Providers
Psychologist
N103TF0200XBehavioral Health & Social Service Providers
Psychologist
N103TM1800XBehavioral Health & Social Service Providers
Psychologist
N103T00000XBehavioral Health & Social Service Providers
Psychologist
N103TP2701XBehavioral Health & Social Service Providers
Psychologist
Y103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist

Other Provider Identifiers:

IssuerNumberStateType
PS04411AK05
NATNL REG-KRISTI FULLER51470AK01
STATE LICENSE KRISTI FULLER436AK01
NPI KRISTI FULLER1700865029AK01
STATE LICENSE MAUREEN YOUNG1022AK01
NPI KRISTA PEMBERTON LCSW119402948801
PSG123AK05
PS8574AK05
NPI RICHARD FULLER1578572947AK01
NATNL REG-RICHARD FULLER51478AK01
STATE LICENSE KRISTA PEMBERTON1023AK01
NPI MAUREEN YOUNG LCSW182139211901
STATE LICENSE RICHARD FULLER441AK01
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







CLINICAL NEUROPSYCHOLOGIST JOBS AK - Page 1



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