Provider Demographics
NPI:1174596118
Name:FUELLING, MARK ANTHONY (LCSW)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANTHONY
Last Name:FUELLING
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:502 BURKARTH RD STE D
Mailing Address - Street 2:PO BOX F
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-0890
Mailing Address - Country:US
Mailing Address - Phone:660-429-6678
Mailing Address - Fax:660-429-6672
Practice Address - Street 1:502 BURKARTH RD
Practice Address - Street 2:STE D
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-0890
Practice Address - Country:US
Practice Address - Phone:660-429-6678
Practice Address - Fax:660-429-6672
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW0029691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO21595013OtherBCBS
MOD544401Medicare ID - Type Unspecified