Amber Rose Fuller, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

2886 Issued in MN

Practice address

2006 1St Ave Ste 201
Anoka, MN 55303-2255

Phone

(763) 647-8188

Fax

(763) 322-0516

NPI assigned

Oct 22, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1413936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573516800000",
    "number": "1891199618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2006 1ST AVE STE 201",
            "city": "ANOKA",
            "state": "MN",
            "postal_code": "553032255",
            "telephone_number": "763-647-8188",
            "fax_number": "763-322-0516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2006 1ST AVE STE 201",
            "city": "ANOKA",
            "state": "MN",
            "postal_code": "553032255",
            "telephone_number": "763-647-8188",
            "fax_number": "763-322-0516"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1539 Grand Ave",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551052229",
            "country_code": "US",
            "telephone_number": "763-647-8188",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLER",
        "first_name": "AMBER",
        "middle_name": "ROSE",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-22",
        "last_updated": "2019-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "2886",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Ann Forrest, PMHNP
• Rose Lynn Fradella
• Michaela Freer
• Jennifer Frick
• Jessica Cecily Friedman
• Jill Fuller
• Brook Marie Gahm
• Keith Charles Gallus, PHARMACY
• Heather P Gammon, M.D
• Elise Garafola, LAC

• Marriage & Family Therapist in Anoka, MN
• Providers in Anoka, MN by specialty
• Marriage & Family Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.