Kristie M Fuller, LMHC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

MH20191 Issued in FL

Practice address

5524 River Oaks Dr
Titusville, FL 32780-7037

Phone

(321) 209-2332

NPI assigned

Jun 19, 2020

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Jean Gautreaux LLC

  • Clinical Social Worker
  • Palm Bay, FL
  • NPI 1336788363
  NPD (past)

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

{
    "created_epoch": "1592524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700179200000",
    "number": "1881210441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5524 RIVER OAKS DR",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327807037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5524 RIVER OAKS DR",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327807037",
            "telephone_number": "321-209-2332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "KRISTIE",
        "middle_name": "M",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-19",
        "last_updated": "2023-11-17",
        "certification_date": "2023-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "FL",
            "license": "MH20191",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "FL",
            "license": "IMH18176",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Fray, PT, DPT
• Fred and Linda Kodesch, MDS
• Mallory Freeman
• Vivian Mashell Freeman, M.A.
• Anita Frost-Lindenblad, ARNP
• Functional Therapy and Wellness LLC
• Jeanette Maria Gabay
• Amy Adams Gadapee, M.S. CCC-SLP
• Elizabeth Turner Galfo, MD
• Mark S Galfo, MD

• Professional Counselor in Titusville, FL
• Providers in Titusville, FL by specialty
• Professional Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 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.