Active NPI
Cheryl Fuller, PHD
- Psychologist
- Fort Worth, TX
National Provider Identifier
1750303269
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 23404
- Practice address
- 1814 8TH Ave # B
Fort Worth, TX 76110-1354 - Phone
- (817) 735-8222
- Fax
- (817) 924-1369
- NPI assigned
- Jul 24, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 23404 | TX | Primary |
Addresses
Primary practice location
1814 8TH Ave # B
Fort Worth, TX 76110-1354
Mailing address
4320 Bellaire Dr S Apt 226W
Fort Worth, TX 76109-5197
Phone (817) 832-9329
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0012JC | Other | TX | BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23404 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282694400000",
"number": "1750303269",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4320 BELLAIRE DR S APT 226W",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761095197",
"telephone_number": "817-832-9329",
"fax_number": "817-924-1369"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1814 8TH AVE # B",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761101354",
"telephone_number": "817-735-8222",
"fax_number": "817-924-1369"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "CHERYL",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-24",
"last_updated": "2010-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "TX",
"license": "23404",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "0012JC",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.