Provider Demographics
NPI:1669760062
Name:FULLAGAR, JAMES (LMSW)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:FULLAGAR
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-2353
Mailing Address - Country:US
Mailing Address - Phone:800-423-1342
Mailing Address - Fax:785-628-3113
Practice Address - Street 1:222 SOUTHWIND PL
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-3123
Practice Address - Country:US
Practice Address - Phone:800-423-1342
Practice Address - Fax:785-628-3113
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4513104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200731690BMedicaid