Provider Demographics
NPI:1114039252
Name:MCMULLEN, KAREN ANN (MED LPC)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:ANN
Last Name:MCMULLEN
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 912
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-0912
Mailing Address - Country:US
Mailing Address - Phone:406-261-9321
Mailing Address - Fax:406-887-9948
Practice Address - Street 1:302 1ST ST W
Practice Address - Street 2:SUITE 202
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-2654
Practice Address - Country:US
Practice Address - Phone:406-261-9321
Practice Address - Fax:406-887-9948
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT149101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT149OtherLICENSE ID
MT75600OtherBLUE CROSS BLUE SHIELD ID