Provider Demographics
NPI:1932504933
Name:CORY J MULLINS, LLC
Entity Type:Organization
Organization Name:CORY J MULLINS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW QIDP
Authorized Official - Phone:248-895-1455
Mailing Address - Street 1:1711 CASS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:KEEGO HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48320-1047
Mailing Address - Country:US
Mailing Address - Phone:248-895-1455
Mailing Address - Fax:248-481-4352
Practice Address - Street 1:1711 CASS LAKE RD
Practice Address - Street 2:
Practice Address - City:KEEGO HARBOR
Practice Address - State:MI
Practice Address - Zip Code:48320-1047
Practice Address - Country:US
Practice Address - Phone:248-895-1455
Practice Address - Fax:248-481-4352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty