Provider Demographics
NPI:1225482383
Name:FULLBRIGHT, STEPHANIE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:FULLBRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202639 E COUNTY ROAD 42
Mailing Address - Street 2:202639 E. COUNTY ROAD 42
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-5442
Mailing Address - Country:US
Mailing Address - Phone:580-254-5322
Mailing Address - Fax:580-254-5335
Practice Address - Street 1:202639 E COUNTY ROAD 42
Practice Address - Street 2:202639 E. COUNTY ROAD 42
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-5442
Practice Address - Country:US
Practice Address - Phone:580-254-5322
Practice Address - Fax:580-254-5335
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor