Provider Demographics
NPI:1003414772
Name:FULBRIGHT, JODY LEE (LPC)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:LEE
Last Name:FULBRIGHT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:LEE
Other - Last Name:GREGORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17000 PRESTON RD STE 350
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1240
Mailing Address - Country:US
Mailing Address - Phone:972-250-1705
Mailing Address - Fax:972-250-1710
Practice Address - Street 1:17000 PRESTON RD STE 350
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1240
Practice Address - Country:US
Practice Address - Phone:972-250-1705
Practice Address - Fax:972-250-1710
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10266101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional