Provider Demographics
NPI:1184289878
Name:CIESLAK-MULLINS, COURTNEY L (MA, LPP)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:L
Last Name:CIESLAK-MULLINS
Suffix:
Gender:F
Credentials:MA, LPP
Other - Prefix:MRS
Other - First Name:COURTNEY
Other - Middle Name:C
Other - Last Name:MULLINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LPP
Mailing Address - Street 1:P.O. BOX 407
Mailing Address - Street 2:
Mailing Address - City:MCDOWELL
Mailing Address - State:KY
Mailing Address - Zip Code:41647
Mailing Address - Country:US
Mailing Address - Phone:606-548-1397
Mailing Address - Fax:
Practice Address - Street 1:9879 ROUTE 122
Practice Address - Street 2:
Practice Address - City:MCDOWELL
Practice Address - State:KY
Practice Address - Zip Code:41647
Practice Address - Country:US
Practice Address - Phone:606-377-3488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY115835103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist