Doctor Name: | LISA JEANNE MULL |
NPI Number: | 1043332349 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSYD |
License Number: | 3317 |
Business Practice Address: | 4102 Pinion Dr Usaf Academy, CO - 808402502 |
Business Phone Number: | 7193335154 |
Business Fax Number: | |
Mailing Address: | 4102 Pinion Dr, USAF ACADEMY |
State: | CO |
Postal Code: | 808402502 |
Phone Number: | 7193335154 |
Fax Number: | |
NPI Enumeration Date: | 04/06/2007 |
NPI Last Update Date: | 05/20/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 3317 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |