Brian Fuller, MS, LMSW, LMHP

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

1978 Issued in NE

Practice address

500 Willow Ave
Suite 305
Council Bluffs, IA 51503-0827

Phone

(712) 256-4420

Fax

(712) 256-4423

NPI assigned

Jun 18, 2007

Last updated

Jun 19, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Family Connections, Inc

  • Adolescent and Children Mental Health Clinic/Center
  • Council Bluffs, IA
  • NPI 1669896346
  NPD
• Family Connections, Inc

  • Case Management Agency
  • Council Bluffs, IA
  • NPI 1740357300
  NPD

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

{
    "created_epoch": "1182124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213833600000",
    "number": "1659576841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 WILLOW AVE",
            "address_2": "SUITE 305",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515030827",
            "telephone_number": "712-256-4420",
            "fax_number": "712-256-4423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 WILLOW AVE",
            "address_2": "SUITE 305",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515030827",
            "telephone_number": "712-256-4420",
            "fax_number": "712-256-4423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "BRIAN",
        "name_prefix": "Mr.",
        "credential": "MS, LMSW, LMHP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-18",
        "last_updated": "2008-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NE",
            "license": "1978",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100253517-00",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1010744",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew Adam Frieze
• Andrew Frohardt
• Matthew F Fryzek, M.D.
• Full Circle Therapy Center, LLC
• Lisa Jane Fullenkamp, MA, CCC-SLP
• Ian Jacob Fullinfaw, DDS
• Daniel Eduardo Galeas Rodriguez, MD
• Annabel Galva, MD
• Linda Mabel Garcia-Dorta, MD
• Devon Garrean, LMHC

• Mental Health Counselor in Council Bluffs, IA
• Providers in Council Bluffs, IA by specialty
• Mental Health Counselor in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2008; 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.