Provider Demographics
NPI:1629481239
Name:MULLENS, MEREDITH (CI)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:MULLENS
Suffix:
Gender:F
Credentials:CI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W LIVE OAK ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-5119
Mailing Address - Country:US
Mailing Address - Phone:512-440-0613
Mailing Address - Fax:512-440-0235
Practice Address - Street 1:400 W LIVE OAK ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-5119
Practice Address - Country:US
Practice Address - Phone:512-440-0613
Practice Address - Fax:512-440-0235
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)