Provider Demographics
NPI:1831342989
Name:MULLINS, COURTNEY J (MA, NCC, LPC)
Entity type:Individual
Prefix:MR
First Name:COURTNEY
Middle Name:J
Last Name:MULLINS
Suffix:
Gender:M
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14175 W INDIAN SCHOOL RD
Mailing Address - Street 2:STE B4 #438
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-8407
Mailing Address - Country:US
Mailing Address - Phone:602-617-6209
Mailing Address - Fax:
Practice Address - Street 1:501 E MAHONEY AVE
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-3223
Practice Address - Country:US
Practice Address - Phone:623-386-6365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-01
Last Update Date:2008-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12699101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health