Provider Demographics
NPI:1851695027
Name:MULLINS, SUZANNE MARIE HEINZL (LCSW)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARIE HEINZL
Last Name:MULLINS
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 1:46 GRAINEY DR
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-3217
Mailing Address - Country:US
Mailing Address - Phone:618-577-0951
Mailing Address - Fax:
Practice Address - Street 1:1115 FRONTAGE RD STE B
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-2093
Practice Address - Country:US
Practice Address - Phone:618-577-0951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0143911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical