Organization
FULLER DIAGNOSTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTI H FULLER PHD, ABPP-CN (OWNER/PARTNER)
(907) 561-0552
Entity
Organization
Contact information
Practice address
2600 DENALI ST, SUITE 450, ANCHORAGE, AK 99503-2746
(907) 561-0552
(907) 561-0562
Mailing address
PO BOX 92303, ANCHORAGE, AK 99509-2303
(907) 561-0552
(907) 561-0562
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
—
—
103T00000X
Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TF0200X
Forensic Psychologist
—
—
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
1041C0700X
Clinical Social Worker
1022
AK
1041C0700X
Clinical Social Worker
1023
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1022
STATE LICENSE MAUREEN YOUNG
AK
01
—
1023
STATE LICENSE KRISTA PEMBERTON
AK
01
—
1194029488
NPI KRISTA PEMBERTON LCSW
—
01
—
1578572947
NPI RICHARD FULLER
AK
01
—
1700865029
NPI KRISTI FULLER
AK
01
—
1821392119
NPI MAUREEN YOUNG LCSW
—
01
—
436
STATE LICENSE KRISTI FULLER
AK
01
—
441
STATE LICENSE RICHARD FULLER
AK
01
—
51470
NATNL REG-KRISTI FULLER
AK
01
—
51478
NATNL REG-RICHARD FULLER
AK
05
—
PS04411
—
AK
05
—
PS8574
—
AK
05
—
PSG123
—
AK
Enumeration date
08/19/2006
Last updated
03/22/2012
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