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General NPI Number Information
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NPI Number | 1811428840
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Entity Type | Organization
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Legal Business Name | TIFFANY FULLER COUNSELING, LLC
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Dates
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Enumeration Date | 03/22/2017
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Last Update Date | 03/22/2017
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Provider Practice Location Address
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Address Line | 16301 SONOMA PARK DR
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City | EDMOND
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State | OK
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Zip | 73013-2091
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Country | US
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Telephone | 405-919-7124
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Fax |
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Provider Business Mailing Address
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Address Line | 16301 SONOMA PARK DR
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City | EDMOND
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State | OK
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Zip | 73013-2091
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Country | US
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Telephone | 405-919-7124
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Fax |
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Authorized Official
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Title or Position | MARRIAGE AND FAMILY THERAPIST
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Name | MRS. TIFFANY LYNN FULLER
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Credential | LMFT
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Telephone | 405-919-7124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1214
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License Number State | OK
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