Provider Demographics
NPI:1376927947
Name:MCMULLEN, CATHY
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:MCMULLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:
Other - Last Name:MCMULLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CSW
Mailing Address - Street 1:308 S 100 W
Mailing Address - Street 2:
Mailing Address - City:TREMONTON
Mailing Address - State:UT
Mailing Address - Zip Code:84337-1804
Mailing Address - Country:US
Mailing Address - Phone:360-335-9215
Mailing Address - Fax:
Practice Address - Street 1:440 W 600 N
Practice Address - Street 2:
Practice Address - City:TREMONTON
Practice Address - State:UT
Practice Address - Zip Code:84337-2400
Practice Address - Country:US
Practice Address - Phone:435-257-2168
Practice Address - Fax:435-257-0318
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
UT9438610-35101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT876000308007Medicaid
UT000055266Medicare PIN