Individual
LACEY DAWN FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
628 E CREEK AVE, MCALESTER, OK 74501-6930
(918) 421-3500
(918) 429-1855
Mailing address
PO BOX 1404, MCALESTER, OK 74502-1404
(918) 421-3500
(918) 429-1855
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
10/05/2009
Last updated
10/05/2009
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