Provider Demographics
NPI:1245418425
Name:MCMULLEN, STEPHANIE KAY (CSW INTERN)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:KAY
Last Name:MCMULLEN
Suffix:
Gender:F
Credentials:CSW INTERN
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:KAY
Other - Last Name:KORF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW, MSW
Mailing Address - Street 1:7475 LA COSTA ST
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-6425
Mailing Address - Country:US
Mailing Address - Phone:775-770-8505
Mailing Address - Fax:775-334-3022
Practice Address - Street 1:745 W MOANA LN
Practice Address - Street 2:SUITE #100
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4932
Practice Address - Country:US
Practice Address - Phone:775-334-3033
Practice Address - Fax:775-334-3022
Is Sole Proprietor?:No
Enumeration Date:2008-02-09
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4655-S104100000X
NVIC9871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker