Fulfillment LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

FULFILLMENT LLC

Practice address

14331 Crego St
Caldwell, ID 83607-4815

Phone

(208) 284-7233

NPI assigned

Jan 9, 2023

Organization subpart

No

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

Authorized official

Name

Kendra Jean Nielson, LPCNPI 1891447751

Title

Manager

Phone

(208) 284-7233

Specialties & licenses 1

Addresses

Tax ID family

Fulfillment LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Fulfillment LLC

  • Mental Health Counselor
  • Caldwell, ID
  • NPI 1346954658
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kendra Jean Nielson

  • Mental Health Counselor
  • Meridian, ID
  • NPI 1891447751
  NPD Authorized official

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

{
    "created_epoch": "1673222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673222400000",
    "number": "1679287296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14331 CREGO ST",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836074815",
            "telephone_number": "208-757-0067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14331 CREGO ST",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836074815",
            "telephone_number": "208-284-7233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULFILLMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-09",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-09",
        "status": "A",
        "authorized_official_last_name": "NIELSON",
        "authorized_official_first_name": "KENDRA",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "208-284-7233",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amie J Fries, RN
• Rachelle C. Friesen, NP-C
• Linnae Frisby, NP
• Jessica Elaine Fu, M.D.
• Fulfillment LLC
• Full Circle Health, Inc.
• Chelsea Fuller, CCC-SLP
• John Fulmore, LCSW
• Molly Gallegos, MA, OTR/L
• Paula K. Garay, M.A., LMFT

• All providers in Caldwell, ID
• Mental Health Clinic/Center (Including Community Mental Health Center) in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2023; 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.