Fuller Behavior Program

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

FULLER BEHAVIOR PROGRAM

Practice address

2803 Riverside Pkwy Apt 4502
Grand Prairie, TX 75050-8747

Phone

(214) 760-9573

NPI assigned

May 3, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Melvin Fuller

Title

Ceo

Phone

(214) 760-9573

Specialties & licenses 1

Addresses

Other names 1

• Fuller Behavior Program Doing business as

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

{
    "created_epoch": "1336003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336003200000",
    "number": "1710246293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2803 RIVERSIDE PKWY APT 4502",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750508747",
            "telephone_number": "214-760-9573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2803 RIVERSIDE PKWY APT 4502",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750508747",
            "telephone_number": "214-760-9573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULLER BEHAVIOR PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-03",
        "last_updated": "2012-05-03",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "MELVIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "214-760-9573",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fuller Behavior Program",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2012; 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.