Provider Demographics
NPI:1477890960
Name:MULLINS, JILL RENE (LMSW)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:RENE
Last Name:MULLINS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:VICKERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1539 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-8509
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6130 LOVERS LN
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-3026
Practice Address - Country:US
Practice Address - Phone:269-501-5017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801093221104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker