Provider Demographics
NPI:1033545082
Name:MULLINS, CRAIG ALLEN (MA, LPC-MH)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:ALLEN
Last Name:MULLINS
Suffix:
Gender:M
Credentials:MA, LPC-MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4447 S CANYON RD STE 5
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-1889
Mailing Address - Country:US
Mailing Address - Phone:605-391-8882
Mailing Address - Fax:605-385-0035
Practice Address - Street 1:4447 S CANYON RD STE 5
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-1889
Practice Address - Country:US
Practice Address - Phone:605-391-8882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD30550101YM0800X
COLPC.0011682101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD2018152Medicaid
CO98578774Medicaid