Burton Fullmer, LPC
Individual provider Active NPI Mental Health Counselor · Salt Lake City, UT
NPI 1295087112 · NPPES record last updated Oct 3, 2012
Key facts
- NPI
- 1295087112
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 3785956004 (UT)
- Practice address
- 5689 S Redwood Rd
Suite 30
Salt Lake City, UT 84123-5447 - Phone
- (801) 268-1715
- Fax
- (801) 268-1783
- NPI assigned
- Oct 3, 2012
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Smile Psychiatry and Behavioral
Practice addresses (Care Compare)
2183 W Main St
Suite A209
Lehi, UT 84043-6760
Phone (801) 406-6256
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240110000837 | UT | Practitioner - Mental Health Counselor | 0547611998 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3785956004 | UT | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Deborah a Christensen PHD & Associates, Inc | Current |
Accepting new patients | |
| Smile Psychiatry and Behavioral | Current |
Accepting new patients |
Locations
14241 S Redwood Rd
Ste 100
Bluffdale, UT 84065
Phone (801) 816-1801
248 E 13800 S
Ste 4
Draper, UT 84020
Phone (702) 483-5044
138 E 12300 S
Unit 328
Draper, UT 84020
Phone (801) 406-6256
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 3785956004 | UT | Yes |
Addresses
Primary practice location
5689 S Redwood Rd
Suite 30
Salt Lake City, UT 84123-5447
Mailing address
5689 S Redwood Rd
Suite 30
Salt Lake City, UT 84123-5447
Phone (801) 268-1715
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3785956004 | Other | UT | PROFESSIONAL LICENSE |
Other providers in Salt Lake City, UT
- Samuel Fuller
- Timothy Fuller
- Trenton C. Fuller
- Chase Brandon Fullerton
- Tamra Fullerton
- Chelyn Crapo Fullmer
- Christine Fullmer
- Jace Paul Fullmer
- Jordan Tara Jaylene Fullmer
- Kent Fullmer
All providers in Salt Lake City, UT · Mental Health Counselor in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 3, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.