Provider Demographics
NPI:1144050071
Name:MCMULLIN, CRYSTALYNN (CMHC)
Entity type:Individual
Prefix:MRS
First Name:CRYSTALYNN
Middle Name:
Last Name:MCMULLIN
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5464 S 875 E
Mailing Address - Street 2:
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-7006
Mailing Address - Country:US
Mailing Address - Phone:801-920-7078
Mailing Address - Fax:
Practice Address - Street 1:1730 E 3100 N STE 2
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040-2408
Practice Address - Country:US
Practice Address - Phone:801-920-7078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT339477-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health