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NPI Code Detail

MEDICARE: MS. SANDI K FULTZ LPC

MEDICARE: MS. SANDI K FULTZ LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor3823OK

General Provider Information

NPI Number : 1477751345
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SANDI K FULTZ LPC
Provider Business Mailing Address
First Line : 10255 E 540 RD
Second Line :
City : CLAREMORE
State : OK
Zip : 74019-0297
Country : US
Telephone Number : 918-587-3888
Fax Number : 918-587-3891
Provider Business Practice Location Address
First Line : 1608 S ELWOOD AVE
Second Line :
City : TULSA
State : OK
Zip : 74119-4208
Country : US
Telephone Number : 918-587-3888
Fax Number : 918-587-3891
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2007
Last Update Date : 07/08/2007

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Directions to “ MS. SANDI K FULTZ LPC” Practice Location

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