Tessa Fultz, LICSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

26216 Issued in MN

Practice address

408 3Rd St Ste 107
Farmington, MN 55024-1355

Phone

(651) 252-4025

Fax

(651) 390-6136

NPI assigned

Apr 2, 2018

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

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

Specialty

Clinical Social Worker

Education

Other, 2017

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

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.

• Lakeview Wellness LLC

  • Social Worker
  • Farmington, MN
  • NPI 1780389189
  Medicare reassignment NPD Authorized official
• Mental Health Specialty Group PA

  • Mental Health Counselor
  • Durham, NC
  • NPI 1801472634

  MN

  Medicare reassignment
• Pure Potential Counseling

  • Counseling Psychologist
  • Farmington, MN
  • NPI 1295357440
  NPD (past)

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

{
    "created_epoch": "1522627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1568968204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 3RD ST STE 107",
            "city": "FARMINGTON",
            "state": "MN",
            "postal_code": "550241355",
            "telephone_number": "507-649-2507",
            "fax_number": "651-661-4168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 3RD ST STE 107",
            "city": "FARMINGTON",
            "state": "MN",
            "postal_code": "550241355",
            "telephone_number": "651-252-4025",
            "fax_number": "651-390-6136"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1919 Broadway St NE",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554131251",
            "country_code": "US",
            "telephone_number": "651-252-4025",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULTZ",
        "first_name": "TESSA",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-02",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MN",
            "license": "26216",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI 2",
            "identifier": "1780389189",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Fitzgerald, SLP
• Barbara Jean Flaherty
• Gabrielle Fox
• Lisa Fox, RN
• Rose Froehle
• Futures of Tomorrow LLC
• Jessica Elizabeth Gallagher, NP
• Pamela Ann Gantner
• Steve Mark Gliva, D.C.
• Golden Grand Home Care LLC

• Social Worker in Farmington, MN
• Providers in Farmington, MN by specialty
• Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.