Provider Demographics
NPI:1417214487
Name:MULLIN, SHERYL (MA, MFT, LPC)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:
Last Name:MULLIN
Suffix:
Gender:F
Credentials:MA, MFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 CASCADIA INDUSTRIAL ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-1159
Mailing Address - Country:US
Mailing Address - Phone:503-371-7393
Mailing Address - Fax:503-576-2634
Practice Address - Street 1:565 UNION ST NE
Practice Address - Street 2:SUITE 204
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2477
Practice Address - Country:US
Practice Address - Phone:503-371-7393
Practice Address - Fax:503-576-2634
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2092101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor