Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 1041C0700X | Social Worker | Clinical | 1022 | ALASKA | No |
| 2 | 1041C0700X | Social Worker | Clinical | 1023 | ALASKA | No |
| 3 | 103TB0200X | Psychologist | Cognitive & Behavioral | | | No |
| 4 | 103TC0700X | Psychologist | Clinical | | | No |
| 5 | 103TC2200X | Psychologist | Clinical Child & Adolescent | | | No |
| 6 | 103TF0200X | Psychologist | Forensic | | | No |
| 7 | 103TM1800X | Psychologist | Intellectual and Developmental Disabilities | | | No |
| 8 | 103T00000X | Psychologist | | | | No |
| 9 | 103TP2701X | Psychologist | Group Psychotherapy | | | No |
| 10 | 103G00000X | Clinical Neuropsychologist | | | | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 1821392119 | OTHER | | NPI MAUREEN YOUNG LCSW |
| 2 | 441 | OTHER | ALASKA | STATE LICENSE RICHARD FULLER |
| 3 | 1700865029 | OTHER | ALASKA | NPI KRISTI FULLER |
| 4 | 1022 | OTHER | ALASKA | STATE LICENSE MAUREEN YOUNG |
| 5 | 1578572947 | OTHER | ALASKA | NPI RICHARD FULLER |
| 6 | PS04411 | MEDICAID | ALASKA | |
| 7 | 1023 | OTHER | ALASKA | STATE LICENSE KRISTA PEMBERTON |
| 8 | 51470 | OTHER | ALASKA | NATNL REG-KRISTI FULLER |
| 9 | 436 | OTHER | ALASKA | STATE LICENSE KRISTI FULLER |
| 10 | 160833 | MEDICARE PIN | | |
| 11 | 51478 | OTHER | ALASKA | NATNL REG-RICHARD FULLER |
| 12 | 163672 | MEDICARE PIN | | |
| 13 | 160671 | MEDICARE ID-TYPE UNSPECIFIED | ALASKA | GROUP MEDICARE NUMBER |
| 14 | 1194029488 | OTHER | | NPI KRISTA PEMBERTON LCSW |
| 15 | 160672 | MEDICARE ID-TYPE UNSPECIFIED | ALASKA | INDIVIDUAL KRISTI FULLER |
| 16 | PS8574 | MEDICAID | ALASKA | |
| 17 | PSG123 | MEDICAID | ALASKA | |
