Doctor Name: | MR. CORY MULLINS |
NPI Number: | 1346546934 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LMSW QMRP |
License Number: | 6801092551 |
Business Practice Address: | 1711 Cass Lake Rd Keego Harbor, MI - 483201047 |
Business Phone Number: | 2488951455 |
Business Fax Number: | 2484814352 |
Mailing Address: | 1711 Cass Lake Rd, KEEGO HARBOR |
State: | MI |
Postal Code: | 483201047 |
Phone Number: | 2488951455 |
Fax Number: | 2484814352 |
NPI Enumeration Date: | 01/31/2011 |
NPI Last Update Date: | 02/24/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 6801092551 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |