Tara Fuller

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

1045 Klotz Rd
Bowling Green, OH 43402-4820

Phone

(419) 352-7588

Fax

(419) 354-4977

NPI assigned

Apr 19, 2022

Last updated

Apr 19, 2022By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wood County Children's Services Association

  dba Children's Resource Center

  • Mental Health Counselor
  • Bowling Green, OH
  • NPI 1447518824
  NPD (past)
• Wood County Children's Services Association

  dba Children's Resource Center

  • Community/Behavioral Health Agency
  • Bowling Green, OH
  • NPI 1679002166
  NPD (past)

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

{
    "created_epoch": "1650326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650326400000",
    "number": "1609519537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 738",
            "city": "BOWLING GREEN",
            "state": "OH",
            "postal_code": "434020738",
            "telephone_number": "419-352-7588",
            "fax_number": "419-354-4977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 KLOTZ RD",
            "city": "BOWLING GREEN",
            "state": "OH",
            "postal_code": "434024820",
            "telephone_number": "419-352-7588",
            "fax_number": "419-354-4977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "TARA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-19",
        "last_updated": "2022-04-19",
        "certification_date": "2022-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elai Freed, LPCC
• Chasady L Freeze, CNP
• Justin Friess
• Kaitlin Frisch
• Kelly Sue Fullenkamp, OTRL
• Functional Foundations LLC
• Katie Funk
• Beth A Fyffe, M.ED.
• Jenna Gable, QMHS
• Megan Galambos

• Behavior Technician in Bowling Green, OH
• Providers in Bowling Green, OH by specialty
• Behavior Technician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2022; 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.