Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003066887 |
---|---|
Provider Name | Crystal Ann Mcmullen |
First Address | Jacksonville, AR 72076-5043 |
Second Address | Little Rock, AR 72205-3326 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2008 |
Last Update Date | 29/09/2008 |