Elise J Fuller, MA, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

69467 Issued in TX

Practice address

16610 Dallas Pkwy
Suite 2100
Dallas, TX 75248-2617

Phone

(972) 733-3988

Fax

(972) 733-3923

NPI assigned

Jan 18, 2013

Last updated

Nov 16, 2014By 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 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1358467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416096000000",
    "number": "1457699969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16610 DALLAS PKWY",
            "address_2": "SUITE 2100",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752482617",
            "telephone_number": "972-733-3988",
            "fax_number": "972-733-3923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16610 DALLAS PKWY",
            "address_2": "SUITE 2100",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752482617",
            "telephone_number": "972-733-3988",
            "fax_number": "972-733-3923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "ELISE",
        "middle_name": "J",
        "credential": "MA, LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-18",
        "last_updated": "2014-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "TX",
            "license": "69467",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TX",
            "license": "69467",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "69467",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dale Eugene Fuller, MD
• Dana A Fuller, MD
• Deborah A Fuller, M.D.
• Dwain Fuller, M.D. .
• Elise Fuller, COTA
• Grant Fuller, OTA
• Jeffrey Fuller
• Julie Marie Fuller, MD
• Kelcie Denea Fuller
• Lakeshia Rena Fuller, RN

• Professional Counselor in Dallas, TX
• Providers in Dallas, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2014; 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.