Provider Demographics
NPI:1023886785
Name:MULLENIX, ANNE MARIE (CAC,CWC,CPC)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:MULLENIX
Suffix:
Gender:F
Credentials:CAC,CWC,CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4954 KELLY AVE
Mailing Address - Street 2:
Mailing Address - City:ROOTSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44272-9288
Mailing Address - Country:US
Mailing Address - Phone:330-842-7487
Mailing Address - Fax:
Practice Address - Street 1:4954 KELLY AVE
Practice Address - Street 2:
Practice Address - City:ROOTSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44272-9288
Practice Address - Country:US
Practice Address - Phone:330-842-7487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0800X
OH171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care