Charidith Fuller, MS

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

1936 Issued in TN

Practice address

391 Broad St. SW
Ste 202
Cleveland, TN 37311

Phone

(423) 641-1105

NPI assigned

Jan 5, 2022

Last updated

Jan 5, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jul 24, 2024 through Jul 24, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cleveland Counseling & Mental Health

  • Marriage & Family Therapist
  • Cleveland, TN
  • NPI 1811763600
  NPD Authorized official

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

{
    "created_epoch": "1641340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641340800000",
    "number": "1144981887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2708 BRYANT DR SW",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373110824",
            "telephone_number": "810-623-5450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "391 BROAD ST. SW",
            "address_2": "STE 202",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "37311",
            "telephone_number": "423-641-1105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "CHARIDITH",
        "credential": "MS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-05",
        "last_updated": "2022-01-05",
        "certification_date": "2022-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "TN",
            "license": "1936",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://portal.therapyappointment.com/index.cfm/messages:main/inbox",
            "affiliation": "N",
            "endpointDescription": "HIPAA Compliant messaging system",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "391 Broad St. SW",
            "address_2": "Ste 202",
            "city": "Cleveland",
            "state": "TN",
            "country_code": "US",
            "postal_code": "37311",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Michael D Fryar, FNP
• Vicki R Frye, PA-C
• Robert Irwin Fulford, R.PH.
• Full Circle Chiropractic
• Katlyn Elizabeth Fullen, DDS
• Karen Fulmer, LMT
• Madison Gabhart, PHD, LMFT
• Gager Therapy Services (Bradley Physical Therapy)
• Steven Gamble, RBT
• Josh Robert Marris Gann

• Marriage & Family Therapist in Cleveland, TN
• Providers in Cleveland, TN by specialty
• Marriage & Family Therapist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.