Individual
OLIVIA D FULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
109 N FAIRLAND ST, PRYOR, OK 74361-4205
(918) 825-1405
(918) 825-1406
Mailing address
109 N FAIRLAND ST, PRYOR, OK 74361-4205
(918) 825-1405
(918) 825-1406
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
06/12/2017
Last updated
08/06/2020
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