Individual provider · Type 1 NPI

Dimitri Fuller

Mental Health Counselor · Canby, OR

NPI number 1053245589 Active

Practice location

22018 S Central Point Rd
Canby, OR 97013-8705

Mailing address

1227 Johnson St
Oregon City, OR 97045-3610

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XNone listed

Mental Health Counselor: Definition to come...

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About NPI 1053245589

Dimitri Fuller's National Provider Identifier is 1053245589, issued on Jun 10, 2026. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Canby, OR. The record was last updated on Jun 10, 2026.