Active NPI
Denise Lynn Fuller, LPC
- Professional Counselor
- Plymouth, MI
National Provider Identifier
1093577405
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6401223945
- Practice address
- 705 S Main St
Plymouth, MI 48170-2089 - Phone
- (734) 985-0638
- NPI assigned
- Jan 30, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 6401223945 | MI | Primary |
Addresses
Primary practice location
705 S Main St
Plymouth, MI 48170-2089
Mailing address
46592 W Oak Manor CT
Canton, MI 48187-5230
Phone (734) 233-4447
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6401223945 | MI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1706572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706572800000",
"number": "1093577405",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "46592 W OAK MANOR CT",
"city": "CANTON",
"state": "MI",
"postal_code": "481875230",
"telephone_number": "734-233-4447"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "705 S MAIN ST",
"city": "PLYMOUTH",
"state": "MI",
"postal_code": "481702089",
"telephone_number": "734-985-0638"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "DENISE",
"middle_name": "LYNN",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-01-30",
"last_updated": "2024-01-30",
"certification_date": "2024-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MI",
"license": "6401223945",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.