Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | CL 60269780 | WA |
NPI | 1003161308 |
---|---|
Provider Name | Tracy Mullen |
First Address | Kennewick, WA 99336-3134 |
Second Address | Kennewick, WA 99336-3134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2012 |
Last Update Date | 23/07/2012 |