Provider Demographics
NPI:1073913950
Name:MULLIN, JESSICA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:MULLIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 N EIGHT TRIBES TRL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-1011
Mailing Address - Country:US
Mailing Address - Phone:918-418-9756
Mailing Address - Fax:
Practice Address - Street 1:21 N EIGHT TRIBES TRL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-1010
Practice Address - Country:US
Practice Address - Phone:417-629-2428
Practice Address - Fax:918-238-4225
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health