MARY-BIANCA GABRIELLE FULLER (NPI# 1952806309) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952806309 |
| Entity Type | Individual |
| Full Name | MARY-BIANCA GABRIELLE FULLER |
| Practice Address |
4152 30th Ave S Ste 104 Fargo ND 58104-8403 |
| Mailing Address |
701 3rd St Nw Jamestown ND 58401-2963 |
| Practice Telephone | 7013642663 |
| Mailing Telephone | 7012523850 |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2018-03-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 106S00000X | Behavior Technician | Behavioral Health & Social Service Providers |
| Street Address |
4152 30TH AVE S STE 104 |
| City | FARGO |
| State | ND |
| Zip Code | 58104-8403 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043837347 | Pinnacle Therapy & Wellness, Pllc | Physical Therapist | 4500 36th Ave S Suite 100, Fargo, ND 58104 | 2020-07-02 |
| 1619509858 | Patricia Helen Bathie | Counselor | 4243 Auburn Ave., Fargo, ND 58104 | 2020-02-05 |
| 1346892866 | Elizabeth Olis | Registered Nurse | 2633 55th St. S, Apartment 202, Fargo, ND 58104 | 2019-07-15 |
| 1780247023 | Keith Kirimi Ndege | Physical Therapy Assistant | 5225 23rd Ave South, Fargo, ND 58104 | 2019-04-22 |
| 1346728557 | Ms4 Pllc | Pharmacy | 4476 31st Avenue South, Suite #105, Fargo, ND 58104 | 2018-07-31 |
| 1891286977 | Jessica Rae Majidian | Dentist | 3030 49th St S, Fargo, ND 58104 | 2018-05-23 |
| 1821588500 | Alissa Nichole Larson | Pharmacist | 5675 26th Ave S St. 136a, Fargo, ND 58104 | 2018-05-17 |
| 1790297430 | Northern Lights Dental | Dentist | 4150 19th Ave S, Suite 301, Fargo, ND 58104 | 2017-11-03 |
| 1619406733 | Cobalt Rehabilitation Hospital Fargo LLC | Rehabilitation Hospital | 4671 38th Street S, Fargo, ND 58104 | 2017-06-12 |
| 1790210318 | Homefield Health, LLC | Clinic/Center | 4141 31st Ave S., Ste 102, Fargo, ND 58104 | 2017-04-21 |
| Find all providers in zip 58104 | ||||
| Taxonomy Code | 106S00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Behavior Technician |
| The behavior technician is a paraprofessional who practices under the close, ongoing supervision of a behavior analyst or assistant behavior analyst certified by the Behavior Analyst Certification Board and/or credentialed by a state (such as through licensure). The behavior technician is primarily responsible for the implementation of components of behavior-analytic treatment plans developed by the supervisor. That may include collecting data on treatment targets and conducting certain types of behavioral assessments (e.g., stimulus preference assessments). The behavior technician does not design treatment or assessment plans or procedures but provides services as assigned by the supervisor responsible for his or her work. |
| Notes: Association of Professional Behavior Analysts, www.apbahome.net and Behavior Analyst Certification Board (http://www.bacb.com) [7/1/2016: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275173569 | Emma Ruth Carlson | Behavior Technician | 2800 Main Ave Ste 400, Fargo, ND 58103-6811 | 2020-01-14 |
| 1780055749 | Joni Britton | Behavior Technician | 4141 31st Ave S Ste 104, Fargo, ND 58104-8778 | 2015-10-15 |
| 1578164588 | Shayley Gifford | Behavior Technician | 2800 Main Ave, Fargo, ND 58103-6811 | 2020-11-05 |
| 1154922201 | Hailen Matthew Ackerman | Behavior Technician | 4725 Amber Valley Pkwy S Ste B, Fargo, ND 58104-8614 | 2020-11-05 |
| 1679174544 | Rylee Smith | Behavior Technician | 2800 Main Ave, Fargo, ND 58103-6811 | 2020-11-05 |
| 1891393112 | Jessica Socorro Mas | Behavior Technician | 4725 Amber Valley Pkwy S Ste B, Fargo, ND 58104-8614 | 2020-10-09 |
| 1700483237 | Brea Christine Frederick | Behavior Technician | 4725 Amber Valley Pkwy S Ste B, Fargo, ND 58104-8614 | 2020-10-07 |
| 1346855434 | Morgyn Miller | Behavior Technician | 4725 Amber Valley Pkwy S Ste B, Fargo, ND 58104-8614 | 2020-09-15 |
| 1003420175 | Alexis Berg | Behavior Technician | 4725 Amber Valley Pkwy S Ste B, Fargo, ND 58104-8614 | 2020-09-04 |
| 1407465396 | Jordey Skylar Brown-smith | Behavior Technician | 2800 Main Ave, Fargo, ND 58103-6811 | 2020-07-27 |
| Find all providers in FARGO | ||||
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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.