Provider Demographics
NPI:1073993903
Name:GRETCHEN MULLIN LLC
Entity Type:Organization
Organization Name:GRETCHEN MULLIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LMHC
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MULLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, CAP
Authorized Official - Phone:727-916-7812
Mailing Address - Street 1:3290 TANGLEWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-1835
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7747 MITCHELL BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4725
Practice Address - Country:US
Practice Address - Phone:727-916-7812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12114305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service