Teresa Antoinette Fuller, LCSW, LCDC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

61810 Issued in TX

Practice address

9898 Bissonnet St Ste 470
Houston, TX 77036-8280

Phone

(281) 888-6137

NPI assigned

Dec 7, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Soulfully Urs, LLC

  • Community/Behavioral Health Agency
  • Houston, TX
  • NPI 1700551447

  Clinical

  NPD Authorized official

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

{
    "created_epoch": "1607299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628812800000",
    "number": "1346846151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1918 WOODVALE DR UNIT B",
            "city": "MISSOURI CITY",
            "state": "TX",
            "postal_code": "774891421",
            "telephone_number": "281-901-9412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9898 BISSONNET ST STE 470",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770368280",
            "telephone_number": "281-888-6137"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1918 Woodvale Dr",
            "address_purpose": "LOCATION",
            "city": "Missouri City",
            "state": "TX",
            "postal_code": "774891421",
            "country_code": "US",
            "telephone_number": "281-901-9412",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLER",
        "first_name": "TERESA",
        "middle_name": "ANTOINETTE",
        "credential": "LCSW, LCDC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-12-07",
        "last_updated": "2021-08-13",
        "certification_date": "2021-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "TX",
            "license": "14286",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "61810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gregory N. Fuller, M.D. PHD
• Lisa Fuller, MD
• Maren Yngve Fuller, M.D.
• Renee Fuller
• Sandra Fogarty Fuller, PT
• Tracy Ann Fuller, MD
• Vicki Fuller
• Joshua Fullerton
• Robert K. Fullick, MD
• Fullilove Prregnancy Center

• Clinical Social Worker in Houston, TX
• Providers in Houston, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.