Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 104258 | KY |
NPI | 1003152257 |
---|---|
Provider Name | Kristal Mullins |
First Address | Burkesville, KY 42717-1080 |
Second Address | Liberty, KY 42539-6762 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2012 |
Last Update Date | 11/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100280340 | (05) | KY |