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DR. THOMAS CHARLES FULLER PHD NPI 1598705675


NPI Information

NPI: 1598705675
Provider Name: DR. THOMAS CHARLES FULLER, PHD
Classification: Clinical Neuropsychologist - 103G00000X
Entity Type: Individual
Organization: HRA PSYCHOLOGICAL SERVICES PC

PECOS Registration: Yes

Address:
161 OTTAWA NW
STE 300C
GRAND RAPIDS, MI
ZIP 49503
Phone: (616) 458-0692
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DR. Thomas Charles Fuller, PHD is a clinical neuropsychologist in Grand Rapids, MI with 36 years of experience. The provider is a clinical psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system. The specialty is dedicated to enhancing the understanding of brain-behavior relationships and the application of such knowledge to human problems. DR. Thomas Charles Fuller, PHD NPI is 1598705675. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

161 OTTAWA NW
STE 300C
GRAND RAPIDS, MI
ZIP 49503-707
Phone: (616) 458-0692
Fax: (616) 458-8129

The NPI 1598705675 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 6/7/2006 and was last updated on 2/3/2011.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1103T00000XPsychologist6301006879MICHIGANNo
2103G00000XClinical Neuropsychologist6301006879MICHIGANYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1R67368MEDICARE UPIN
20D14603MEDICARE ID-TYPE UNSPECIFIED

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.