Active NPI
Aileen Fullchange, LP
- Clinical Psychologist
- Dallas, TX
National Provider Identifier
1386281756
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 37995
- Practice address
- 3500 Oak Lawn Ave Ste 230
Dallas, TX 75219-4369 - Phone
- (214) 247-6410
- NPI assigned
- Dec 4, 2019
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | 37995 | TX | |
| Family Psychologist | 103TF0000X | 37995 | TX | |
| Health Service Psychologist | 103TH0100X | 37995 | TX | |
| Clinical Psychologist | 103TC0700X | 37995 | TX | Primary |
Addresses
Primary practice location
3500 Oak Lawn Ave Ste 230
Dallas, TX 75219-4369
Mailing address
2807 Throckmorton St Apt 101
Dallas, TX 75219-6204
Phone (510) 685-8593
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 |
|---|---|---|---|
| 37995 | TX | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1575417600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1575417600000",
"number": "1386281756",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2807 THROCKMORTON ST APT 101",
"city": "DALLAS",
"state": "TX",
"postal_code": "752196204",
"telephone_number": "510-685-8593"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3500 OAK LAWN AVE STE 230",
"city": "DALLAS",
"state": "TX",
"postal_code": "752194369",
"telephone_number": "214-247-6410"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLCHANGE",
"first_name": "AILEEN",
"name_prefix": "Dr.",
"credential": "LP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-12-04",
"last_updated": "2019-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "TX",
"license": "37995",
"primary": false
},
{
"code": "103TF0000X",
"taxonomy_group": "",
"desc": "Psychologist, Family",
"state": "TX",
"license": "37995",
"primary": false
},
{
"code": "103TH0100X",
"taxonomy_group": "",
"desc": "Psychologist, Health Service",
"state": "TX",
"license": "37995",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TX",
"license": "37995",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
- Angela K Fulgham-Gardner, MD
- Pat Fox Fulgham, M.D.
- Dawn Maria Fulghum, LPTA
- Full Circle Counseling and Family Services, PLLC
- Full Life Outreach Medical Center LLC (Full Life Outreach Center)
- Andrea Nicole Fuller, PA-C
- Dale Eugene Fuller, MD
- Dana A Fuller, MD
- Deborah A Fuller, M.D.
- Dwain Fuller, M.D. .
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.