Katherine Angel Fuller

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801089969 Issued in MI

Practice address

1785 W Stadium Blvd Ste 201C
Ann Arbor, MI 48103-5291

Phone

(734) 255-3342

Fax

(844) 364-8448

NPI assigned

May 4, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Kit Fuller, LMSW, LLC

  • Clinical Social Worker
  • Ann Arbor, MI
  • NPI 1700305687
  Medicare reassignment NPD Authorized official
• Samaritan Counseling Center of Southeastern Michigan

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Farmington Hills, MI
  • NPI 1043373137
  NPD (past)
• Samaritan Counseling Services

  • Mental Health Counselor
  • Ann Arbor, MI
  • NPI 1912082306
  NPD (past)

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1407068281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1403 IROQUOIS PL",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481044637",
            "telephone_number": "734-255-3342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1785 W STADIUM BLVD STE 201C",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481035291",
            "telephone_number": "734-255-3342",
            "fax_number": "844-364-8448"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2890 Carpenter Rd",
            "address_2": "Suite 1600",
            "address_purpose": "LOCATION",
            "city": "Ann Arbor",
            "state": "MI",
            "postal_code": "481081100",
            "country_code": "US",
            "telephone_number": "734-677-0609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLER",
        "first_name": "KATHERINE",
        "middle_name": "ANGEL",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-04",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801089969",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "P14910005",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Full Life Independence, LLC
• Genaro Dagan Fullano, ATC
• Douglas R Fullen, MD
• Emily Fuller-Lechton
• Duncan David Frederick Fuller, MD
• Ryan Fuller
• Erika Rozalia Fulop-Cristiu, MD
• Christina Fulton
• Velina Elizabeth Fulton, NP
• Christopher Mon-Chee Fung, M.D.

• Clinical Social Worker in Ann Arbor, MI
• Providers in Ann Arbor, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.