Provider Demographics
NPI:1508462144
Name:MULLENAX, EMILY ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:EMILY
Middle Name:ELIZABETH
Last Name:MULLENAX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 E CHASE AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-3611
Mailing Address - Country:US
Mailing Address - Phone:409-225-7803
Mailing Address - Fax:
Practice Address - Street 1:1399 S 700 E STE 11
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-2124
Practice Address - Country:US
Practice Address - Phone:385-313-8278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10507240-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical