Provider Demographics
NPI:1548347081
Name:MULLIN, KIMBERLY (LPC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:MULLIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 10TH AVE SOUTH
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39701
Mailing Address - Country:US
Mailing Address - Phone:662-352-9484
Mailing Address - Fax:
Practice Address - Street 1:700 10TH AVE SOUTH
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39701
Practice Address - Country:US
Practice Address - Phone:662-352-9484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1192101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health