Provider Demographics
NPI:1902425390
Name:KRIS MULHOLLEN LLC
Entity Type:Organization
Organization Name:KRIS MULHOLLEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:MULHOLLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC
Authorized Official - Phone:813-618-3150
Mailing Address - Street 1:5124 FALLEN LEAF DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-4738
Mailing Address - Country:US
Mailing Address - Phone:813-618-3150
Mailing Address - Fax:
Practice Address - Street 1:1200 W PLATT ST STE 202
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2136
Practice Address - Country:US
Practice Address - Phone:813-618-3150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health