Individual
MR. AUNDRA LAMAR FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10922 E. 39TH ST., TULSA, OK 74146
(918) 282-6850
Mailing address
10922 E 39TH ST, TULSA, OK 74146-2703
(918) 282-6850
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
99999999999999999999
OK
171M00000X
Case Manager/Care Coordinator
Primary
99999999999999999999
OK
Other
Enumeration date
06/06/2012
Last updated
06/06/2012
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