Provider Demographics
NPI:1477170686
Name:MULLINS SPEECH THERAPY, LLC
Entity Type:Organization
Organization Name:MULLINS SPEECH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:601-731-0997
Mailing Address - Street 1:63 NICOLAUS DR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8113
Mailing Address - Country:US
Mailing Address - Phone:601-731-0997
Mailing Address - Fax:601-255-8630
Practice Address - Street 1:5268 OLD HIGHWAY 11 STE 9A
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8379
Practice Address - Country:US
Practice Address - Phone:601-303-1116
Practice Address - Fax:601-255-8630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty