Doctor Name: | KIMBERLY MULLINS |
NPI Number: | 1164656617 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PCC |
License Number: | E0007670 |
Business Practice Address: | 1229 Lincoln Hwy Van Wert, OH - 458911877 |
Business Phone Number: | 4192381695 |
Business Fax Number: | 4192381747 |
Mailing Address: | 1229 Lincoln Hwy, Po Box 150 VAN WERT |
State: | OH |
Postal Code: | 458911877 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 05/13/2009 |
NPI Last Update Date: | 05/13/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | E0007670 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |