Provider Demographics
NPI:1144605197
Name:PROFESSIONAL SERVICES OF SHERRY MULLINS, LLC
Entity Type:Organization
Organization Name:PROFESSIONAL SERVICES OF SHERRY MULLINS, LLC
Other - Org Name:HEYOKA COUNSELING SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC
Authorized Official - Phone:248-430-4224
Mailing Address - Street 1:1624 MARK HOPKINS RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-2647
Mailing Address - Country:US
Mailing Address - Phone:248-430-4224
Mailing Address - Fax:
Practice Address - Street 1:23023 ORCHARD LAKE RD
Practice Address - Street 2:G1
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-3209
Practice Address - Country:US
Practice Address - Phone:248-430-4224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005021251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health