Doctor Name: | MR. JIMMY LEE FULLER |
NPI Number: | 1336464635 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MA, LPC |
License Number: | |
Business Practice Address: | 1950 N Okmulgee Okmulgee, OK - 744476534 |
Business Phone Number: | 9187567700 |
Business Fax Number: | 9187563347 |
Mailing Address: | 1950 N Okmulgee, OKMULGEE |
State: | OK |
Postal Code: | 744476534 |
Phone Number: | 9187567700 |
Fax Number: | 9187563347 |
NPI Enumeration Date: | 03/30/2010 |
NPI Last Update Date: | 02/26/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |