Provider Demographics
NPI:1104137389
Name:MULLIS, HERMAN THOMAS (PHD, LPC, LMFT)
Entity type:Individual
Prefix:DR
First Name:HERMAN
Middle Name:THOMAS
Last Name:MULLIS
Suffix:
Gender:M
Credentials:PHD, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 MOYE RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORDSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24167-3530
Mailing Address - Country:US
Mailing Address - Phone:540-818-0566
Mailing Address - Fax:
Practice Address - Street 1:1999 S MAIN ST
Practice Address - Street 2:SUITE J
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6634
Practice Address - Country:US
Practice Address - Phone:540-818-0566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701000211101YP2500X
VA0717000606106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist