Healthcare Provider Details

I. General information

NPI: 1346577830
Provider Name (Legal Business Name): BRANDI K FULGHAM MCP, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2009
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 S OKLAHOMA AVE
CHEROKEE OK
73728-2545
US

IV. Provider business mailing address

405 S OKLAHOMA AVE
CHEROKEE OK
73728-2545
US

V. Phone/Fax

Practice location:
  • Phone: 580-596-2800
  • Fax: 580-596-2805
Mailing address:
  • Phone: 580-596-2800
  • Fax: 580-596-2805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3694
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number3694
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: