Kristina Fuller, LPCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

104177 Issued in KY

Practice address

1048 Ashley St
Bowling Green, KY 42103-2449

Phone

(270) 904-6567

Fax

(270) 904-6570

NPI assigned

Mar 8, 2014

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

Other names 1

• Kristina Watt Former name

Medicare fee-for-service enrollment

Enrolled in KY

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

Mental Health Counselor

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

KW Consulting LLCGroup PAC ID 6901291756, 26 clinicians

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.

• KW Consulting, LLC

  dba Fuller Life Counseling

  • Mental Health Counselor
  • Bowling Green, KY
  • NPI 1679127781
  Medicare reassignment Care Compare group NPD Authorized official
• Fuller Life Health and Wellness

  • Primary Care Nurse Practitioner
  • Bowling Green, KY
  • NPI 1396625570
  NPD Authorized official

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

{
    "created_epoch": "1394236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563148800000",
    "number": "1700202272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "431 CLAYPOOL BOYCE RD",
            "city": "ALVATON",
            "state": "KY",
            "postal_code": "421228732",
            "telephone_number": "270-791-8189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1048 ASHLEY ST",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421032449",
            "telephone_number": "270-904-6567",
            "fax_number": "270-904-6570"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "431 Claypool Boyce Rd",
            "address_purpose": "LOCATION",
            "city": "Alvaton",
            "state": "KY",
            "postal_code": "421228732",
            "country_code": "US",
            "telephone_number": "270-791-8189",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLER",
        "first_name": "KRISTINA",
        "name_prefix": "Ms.",
        "credential": "LPCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-03-08",
        "last_updated": "2019-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "KY",
            "license": "KY0572",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "KY",
            "license": "104177",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100287000",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTINA",
            "last_name": "WATT",
            "credential": "LPCC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Clara Frost
• Dylan Cody Fugate
• Full Life Counseling Service, PSC
• Fuller Life Health and Wellness
• Callie Brooke Fuller, MSW, CSW
• Megan Fuller, PT, DPT
• Megan Rae Fults, M.S., BCBA
• Austin Fultz, CRNA DNAP
• Jan J Funk, APRN, BC
• Rebecca Fuqua, APRN

• Mental Health Counselor in Bowling Green, KY
• Providers in Bowling Green, KY by specialty
• Mental Health Counselor in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2019; 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.