Active NPI
Angel M Fuller, SUDP-T
- Student in an Organized Health Care Education/Training Program
- Seattle, WA
National Provider Identifier
1659099042
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 11000 Lake City Way NE
Seattle, WA 98125-6748 - Phone
- (206) 901-2000
- Fax
- (206) 901-2010
- NPI assigned
- Aug 22, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | WA | Primary | |
| Counselor | 101Y00000X | 61040159 | WA |
Addresses
Primary practice location
11000 Lake City Way NE
Seattle, WA 98125-6748
Mailing address
6400 Southcenter Blvd
Tukwila, WA 98188-2547
Phone (206) 901-2000
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 |
|---|---|---|---|
| 61040159 | WA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1661126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787875200000",
"number": "1659099042",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6400 SOUTHCENTER BLVD",
"city": "TUKWILA",
"state": "WA",
"postal_code": "981882547",
"telephone_number": "206-901-2000",
"fax_number": "206-901-2010"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11000 LAKE CITY WAY NE",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981256748",
"telephone_number": "206-901-2000",
"fax_number": "206-901-2010"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "ANGEL",
"middle_name": "M",
"credential": "SUDP-T",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-08-22",
"last_updated": "2026-08-28",
"certification_date": "2026-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "WA",
"license": null,
"primary": true
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WA",
"license": "61040159",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.