Individual provider Active NPI

Louise Ella Fullerton, LPC

  • Counselor
  • Salem, OR
National Provider Identifier
1891702767
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
C0696 Issued in OR
Practice address
290 Moyer LN NW
Easter Seas Children'S Guild
Salem, OR 97304
Phone
(503) 370-8990
Fax
(503) 363-4214
NPI assigned
Aug 2, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X C0696 OR Primary

Addresses

Primary practice location

290 Moyer LN NW
Easter Seas Children'S Guild
Salem, OR 97304

Mailing address

710 Stewart St NE
Salem, OR 97301-2515
Phone (503) 371-7496

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
C0696ORMDCounselor

Practice roles

OrganizationSpecialtyStatusNew patients
Easter Seals Oregon Children'S Therapy Center Past Accepting new patients
Easter Seals Oregon Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1891702767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 STEWART ST NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973012515",
            "telephone_number": "503-371-7496",
            "fax_number": "503-363-4214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 MOYER LN NW",
            "address_2": "EASTER SEAS CHILDREN'S GUILD",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "97304",
            "telephone_number": "503-370-8990",
            "fax_number": "503-363-4214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLERTON",
        "first_name": "LOUISE",
        "middle_name": "ELLA",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OR",
            "license": "C0696",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.