Provider Demographics
NPI:1033545082
Name:MULLINS, CRAIG ALLEN (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:ALLEN
Last Name:MULLINS
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E SAINT VRAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1123
Mailing Address - Country:US
Mailing Address - Phone:719-640-6317
Mailing Address - Fax:
Practice Address - Street 1:309 E SAINT VRAIN ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1123
Practice Address - Country:US
Practice Address - Phone:719-640-6317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0011682101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO98578774Medicaid