John Patrick Fullam, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LPC.0016660 Issued in CO

Practice address

725 Main St
Carbondale, CO 81623-1936

Phone

(973) 714-3036

NPI assigned

Nov 12, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1605139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605139200000",
    "number": "1720680945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 MAIN CT",
            "city": "CARBONDALE",
            "state": "CO",
            "postal_code": "816231851",
            "telephone_number": "973-714-3036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 MAIN ST",
            "city": "CARBONDALE",
            "state": "CO",
            "postal_code": "816231936",
            "telephone_number": "973-714-3036"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "811 Main Ct",
            "address_purpose": "LOCATION",
            "city": "Carbondale",
            "state": "CO",
            "postal_code": "816231851",
            "country_code": "US",
            "telephone_number": "973-714-3036",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLAM",
        "first_name": "JOHN",
        "middle_name": "PATRICK",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-11-12",
        "last_updated": "2020-11-12",
        "certification_date": "2020-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CO",
            "license": "LPC.0016660",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "LPC.0016660",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Carbondale, CO
• Providers in Carbondale, CO by specialty
• Mental Health Counselor in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2020; 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.