Provider Demographics
NPI:1770660342
Name:MULLEN, DEBRA A (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
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 1:1825 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-2316
Mailing Address - Country:US
Mailing Address - Phone:920-272-8234
Mailing Address - Fax:
Practice Address - Street 1:3900 HALL AVE STE C
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-1062
Practice Address - Country:US
Practice Address - Phone:715-735-7802
Practice Address - Fax:651-323-2648
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WI4253-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40997200Medicaid