Individual
MR. CARL FULLER JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
1869 E 17TH ST, TULSA, OK 74104-5304
(405) 549-4356
Mailing address
1869 E 17TH ST, TULSA, OK 74104-5304
(405) 549-4356
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
20646
OK
Other
Enumeration date
05/22/2025
Last updated
05/22/2025
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