Provider Demographics
NPI:1811298607
Name:MULLEN, JESSICA I
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:I
Last Name:MULLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 BARBARADALE CIR
Mailing Address - Street 2:N/A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5160
Mailing Address - Country:US
Mailing Address - Phone:702-418-2946
Mailing Address - Fax:
Practice Address - Street 1:2611 BARBARADALE CIR
Practice Address - Street 2:N/A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5160
Practice Address - Country:US
Practice Address - Phone:702-418-2946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation