Individual
LATISHA FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5125 S UTICA AVE APT 4, TULSA, OK 74105-5727
(918) 734-5259
Mailing address
5125 S UTICA AVE APT 4, TULSA, OK 74105-5727
(918) 734-5259
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
03/25/2013
Last updated
03/25/2013
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