Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 10266 | TX |
NPI | 1003414772 |
---|---|
Provider Name | Jody Lee Fulbright |
First Address | Dallas, TX 75248-1240 |
Second Address | Dallas, TX 75248-1240 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2020 |
Last Update Date | 14/10/2020 |