Local City Search for Psychiatrists, Psychologists, Therapists, Counselors and Mental Health Treatment CentersFULLER 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:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
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:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 103G00000X | Behavioral Health & Social Service Providers Clinical Neuropsychologist | ||
| N | 103T00000X | Behavioral Health & Social Service Providers Psychologist | ||
| N | 103TB0200X | Behavioral Health & Social Service Providers Psychologist | ||
| N | 103TC0700X | Behavioral Health & Social Service Providers Psychologist | ||
| N | 103TC2200X | Behavioral Health & Social Service Providers Psychologist | ||
| N | 103TF0200X | Behavioral Health & Social Service Providers Psychologist | ||
| N | 103TM1800X | Behavioral Health & Social Service Providers Psychologist | ||
| N | 103TP2701X | Behavioral Health & Social Service Providers Psychologist | ||
| N | 1041C0700X | Behavioral Health & Social Service Providers Social Worker | AK | 1023 |
| N | 1041C0700X | Behavioral Health & Social Service Providers Social Worker | AK | 1022 |
Other Provider Identifiers:
| Issuer | Number | State | Type |
|---|---|---|---|
| PS04411 | AK | 05 | |
| NATNL REG-KRISTI FULLER | 51470 | AK | 01 |
| STATE LICENSE KRISTI FULLER | 436 | AK | 01 |
| NPI KRISTI FULLER | 1700865029 | AK | 01 |
| STATE LICENSE MAUREEN YOUNG | 1022 | AK | 01 |
| NPI KRISTA PEMBERTON LCSW | 1194029488 | 01 | |
| PSG123 | AK | 05 | |
| PS8574 | AK | 05 | |
| NPI RICHARD FULLER | 1578572947 | AK | 01 |
| NATNL REG-RICHARD FULLER | 51478 | AK | 01 |
| STATE LICENSE KRISTA PEMBERTON | 1023 | AK | 01 |
| NPI MAUREEN YOUNG LCSW | 1821392119 | 01 | |
| STATE LICENSE RICHARD FULLER | 441 | AK | 01 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
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