Provider Demographics
NPI:1881983948
Name:FULLER, JENNIFER KATHRYN (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KATHRYN
Last Name:FULLER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4322 S 180TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74134-7461
Mailing Address - Country:US
Mailing Address - Phone:918-864-1806
Mailing Address - Fax:
Practice Address - Street 1:4322 S 180TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74134-7461
Practice Address - Country:US
Practice Address - Phone:918-864-1806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-29
Last Update Date:2024-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor