Provider Demographics
NPI:1437453115
Name:MULLENIX, DENNIS JOHN II (LMFT)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:JOHN
Last Name:MULLENIX
Suffix:II
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4344 LATHAM ST STE 110
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-1773
Mailing Address - Country:US
Mailing Address - Phone:951-779-4917
Mailing Address - Fax:951-602-6300
Practice Address - Street 1:4344 LATHAM ST STE 110
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-1773
Practice Address - Country:US
Practice Address - Phone:951-779-4917
Practice Address - Fax:951-602-6300
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
CA91081106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No174H00000XOther Service ProvidersHealth Educator