Provider Demographics
NPI:1780493213
Name:MULLINS, NATHANIEL (MACC)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:MULLINS
Suffix:
Gender:M
Credentials:MACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 ALONGSIDE LN
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49083-8633
Mailing Address - Country:US
Mailing Address - Phone:269-447-2100
Mailing Address - Fax:
Practice Address - Street 1:6701 ALONGSIDE LN
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MI
Practice Address - Zip Code:49083-8633
Practice Address - Country:US
Practice Address - Phone:269-447-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451024086101YM0800X
NCA19314101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health