Provider Demographics
NPI:1578228961
Name:MULLEN, KELLI GRACE (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:GRACE
Last Name:MULLEN
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 1:570 REVOLUTION AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-1522
Mailing Address - Country:US
Mailing Address - Phone:406-697-4189
Mailing Address - Fax:
Practice Address - Street 1:3737 GRAND AVE STE 6
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6258
Practice Address - Country:US
Practice Address - Phone:406-839-2985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT506611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical