Provider Demographics
NPI:1346793775
Name:MULLEN, GAYLE (EDD)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:
Last Name:MULLEN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76309-2104
Mailing Address - Country:US
Mailing Address - Phone:940-867-3959
Mailing Address - Fax:940-228-0625
Practice Address - Street 1:3100 10TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76309-2104
Practice Address - Country:US
Practice Address - Phone:940-867-3959
Practice Address - Fax:940-228-0625
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68414101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional