Mary-Bianca Gabrielle Fuller

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

2000 N Racine Ave Ste 3300
Chicago, IL 60614-7008

Phone

(312) 485-3669

NPI assigned

Mar 28, 2018

Last updated

Aug 30, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Abbie Kelley, LLC

  dba AMK Counseling

  • Mental Health Counselor
  • Chicago, IL
  • NPI 1386048825
  NPD

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

{
    "created_epoch": "1522195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693353600000",
    "number": "1952806309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 N RACINE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606147006",
            "telephone_number": "312-485-3669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 N RACINE AVE STE 3300",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606147008",
            "telephone_number": "312-485-3669"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4152 30th Ave S Ste 104",
            "address_purpose": "LOCATION",
            "city": "Fargo",
            "state": "ND",
            "postal_code": "581048403",
            "country_code": "US",
            "telephone_number": "701-364-2663",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLER",
        "first_name": "MARY-BIANCA",
        "middle_name": "GABRIELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-28",
        "last_updated": "2023-08-30",
        "certification_date": "2023-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Lynne Fuller, LCPC
• Jillian Fuller, PHARMD, BCPS
• Lamona Denene Fuller, RN
• Lashonda Fuller, PH.D.
• Lindsay Fuller
• Michael Alan Fuller, MD
• Rachel Marie Fuller, PT, DPT
• Fullerton Dental Island LLC
• Fullerton Drake Medical Center
• Fullerton Family Dentistry, LTD

• Mental Health Counselor in Chicago, IL
• Providers in Chicago, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 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.