Provider Demographics
NPI:1326247081
Name:MULLINS, KIM (MS,LADC/US)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:MULLINS
Suffix:
Gender:F
Credentials:MS,LADC/US
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 SW A AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-3821
Mailing Address - Country:US
Mailing Address - Phone:580-357-6889
Mailing Address - Fax:580-248-1090
Practice Address - Street 1:1202 SW A AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3821
Practice Address - Country:US
Practice Address - Phone:580-357-6889
Practice Address - Fax:580-248-1090
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional