Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PY0677 | NV |
N | 103T00000X | Psychologist | PY0677 | NV |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PY0677 | NV |
NPI | 1073687166 |
---|---|
Provider Name | Dr. Bree Marie Mullin |
First Address | Henderson, NV 89052-2735 |
Second Address | Las Vegas, NV 89117-2749 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 17/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100525083 | (05) | NV |