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NPI Code Detail

MEDICARE: MRS. JENNIFER KATHRYN FULLER MA, LPC

MEDICARE: MRS. JENNIFER KATHRYN FULLER MA, 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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1881983948
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER KATHRYN FULLER MA, LPC
Provider Business Mailing Address
First Line : 4322 S 180TH EAST AVE
Second Line :
City : TULSA
State : OK
Zip : 74134-7461
Country : US
Telephone Number : 918-864-1806
Fax Number :
Provider Business Practice Location Address
First Line : 4322 S 180TH EAST AVE
Second Line :
City : TULSA
State : OK
Zip : 74134-7461
Country : US
Telephone Number : 918-864-1806
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2011
Last Update Date : 02/25/2026

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