MR. BRIAN JAY FULLER (NPI# 1942258595) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942258595 |
| Entity Type | Individual |
| Full Name | MR. BRIAN JAY FULLER |
| Credential | PH.D. |
| Practice Address |
1662 E Centre Ave Portage MI 49002-4410 |
| Mailing Address |
5340 Holiday Ter Kalamazoo MI 49009-2196 |
| Practice Telephone | 2693218564 |
| Mailing Telephone | 2693218564 |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2012-06-19 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103T00000X | Psychologist | 6301013172 | MI | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760674725 | Brian Scott Fuller | Dentist | 1920 S 1st St, 1509, Minneapolis, MN 55454-1055 | 2007-08-14 |
| 1316035280 | Brian Christopher Fuller | Pediatrics | 2401 Village Professional Drive, Opelika, AL 36801-4702 | 2006-10-10 |
| 1073556544 | Brian Jay Fuller | Chiropractor | 211 N Clinton St, Suite 2s, Chicago, IL 60661-1282 | 2006-06-13 |
| 1972562601 | Brian George Fuller | Physical Therapist | 15 Porters Glen Pl, Durham, NC 27713-9164 | 2006-03-21 |
| 1730174160 | Brian J Fuller | Physical Therapist | 4453 State Route 159, Chillicothe, OH 45601-8620 | 2005-09-12 |
| 1427540178 | Brian Fuller | Pediatrics | 1200 S Cedar Crest Blvd, Allentown, PA 18103-6202 | 2018-05-30 |
| 1184915365 | Brian Robert Fuller | Pharmacist | 105 Mall Blvd, Monroeville, PA 15146-2230 | 2011-04-22 |
| 1033409438 | Brian Edward Fuller | Psychiatry & Neurology | 6107 Pinewood Rd, Nunnelly, TN 37137-2523 | 2011-04-19 |
| 1780973982 | Brian J Fuller | Family Medicine | 6909 Good Samaritan Dr, Suite A, Cincinnati, OH 45247-5208 | 2011-03-29 |
| 1336473032 | Brian K Fuller | Case Manager/Care Coordinator | 3211 Jefferson St, San Diego, CA 92110-4424 | 2009-09-28 |
| Street Address |
1662 E CENTRE AVE |
| City | PORTAGE |
| State | MI |
| Zip Code | 49002-4410 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528044765 | Sharyl Lynn St. John | Social Worker | 1662 E Centre Ave, Suite B, Portage, MI 49002-4410 | 2005-12-20 |
| 1205396199 | Ronicka D Hamilton | Counselor | 1662 E Centre Ave, Portage, MI 49002-4496 | 2019-03-25 |
| 1881946911 | Carrie J Tremble | Counselor | 1662 E Centre Ave, Portage, MI 49002-4496 | 2012-10-13 |
| 1174872881 | Aimee Leah Peters | Counselor | 1662 E Centre Ave, Portage, MI 49002-4496 | 2012-09-10 |
| 1518244011 | Michele Lynn Mcgrady | Psychologist | 1662 E Centre Ave, Portage, MI 49002-4496 | 2011-11-11 |
| 1730405515 | Christen Howard-connor | Counselor | 1662 E Centre Ave, Portage, MI 49002-4496 | 2010-04-19 |
| 1144433756 | Sheri L Heflin | Psychologist | 1662 E Centre Ave, Portage, MI 49002-4410 | 2007-05-08 |
| 1578603957 | Shannon L Hilton-smith | Psychologist | 1662 E Centre Ave, Portage, MI 49002-4496 | 2007-02-07 |
| 1700858297 | Nancy J. Hein | Social Worker | 1662 E Centre Ave, Portage, MI 49002-4410 | 2006-02-07 |
| 1396721247 | Timothy James Howard | Psychologist | 1662 E Centre Ave, Portage, MI 49002-4410 | 2005-12-21 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932604204 | Susan Vandewalker | Physical Therapist | 8001 Angling Rd., Portage, MI 49002 | 2018-03-28 |
| 1134634934 | Portage Chiropractic and Wellness Center | Chiropractor | 609 E. Centre, Portage, MI 49002 | 2017-12-04 |
| 1548620537 | Patricia Eid | Behavioral Analyst | 1016 E Milham Ave, Suite 2, Portage, MI 49002 | 2016-03-03 |
| 1386045383 | Pinnacle Senior Care of Kalamazoo, LLC | Home Health | 2725 Airview Blvd Ste 105b, Portage, MI 49002 | 2014-09-09 |
| 1104241611 | Meredith Ayers Holland | Behavioral Analyst | 9616 Portage Road, Portage, MI 49002 | 2014-02-20 |
| 1619211919 | Daketia L Thomas | Massage Therapist | 8314 Portage Rd, Suite D, Kalamazoo, MI 49002 | 2012-11-27 |
| 1831457142 | Kinetic Kids, LLC | Occupational Therapist | 540 East Milham, Portage, MI 49002 | 2012-04-25 |
| 1154689404 | Lauren Michelle Mattaliano | Occupational Therapist | 540 E. Milham Road, Portage, MI 49002 | 2012-04-24 |
| 1114219227 | South Michigan Psychiatric Services LLC | Psychiatry & Neurology | 5390 Lovers Ln, Third Floor, Portage, MI 49002 | 2011-05-07 |
| 1174836316 | Premier Neuropsychiatry Plc | Psychiatry & Neurology | 5930 Lovers Lane, Portage, MI 49002 | 2010-07-16 |
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| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215593934 | Letetsia Fox | Psychologist | 1400 W Milham Ave, Portage, MI 49024-1209 | 2019-05-17 |
| 1912209156 | Shamika Hall | Psychologist | 7901 S 12th St Ste 201, Portage, MI 49024-3831 | 2010-11-19 |
| 1952597767 | Jayne Fabry, Ptc Associates | Psychologist | 1651 W Centre Ave, Portage, MI 49024-6312 | 2007-09-15 |
| 1437342565 | Emily Walker Sherwood | Psychologist | 1604 Timberlane Dr, Portage, MI 49024-5705 | 2007-08-22 |
| 1083727192 | Lee Carlin Sanders | Psychologist | 10056 Woodlawn Dr, Portage, MI 49002-7207 | 2006-08-16 |
| 1235151333 | Joyce Scully | Psychologist | 78 Ski Hill Rd, Portage, IN 46368-8719 | 2006-07-25 |
| 1033169008 | Patricia Shull-blood | Psychologist | 5148 Lovers Ln, Suite 200, Portage, MI 49002-1572 | 2006-05-11 |
| 1649245655 | Patricia Ann Lyman | Psychologist | 5220 Lovers Ln, Suite 120, Portage, MI 49002-1599 | 2006-02-22 |
| 1477530392 | Michael V Bloom | Psychologist | 7920 Kirkland Ct, Portage, MI 49024-4974 | 2005-12-30 |
| 1598746778 | James Darrell Cowart | Psychologist | 5100 Lovers Ln, Trestlewood, Bldg. D, Portage, MI 49002-1558 | 2005-11-07 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.