Provider Demographics
NPI:1124090527
Name:MULLIKIN, MARCIA LYNN (MA)
Entity type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:LYNN
Last Name:MULLIKIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3641 KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5757
Mailing Address - Country:US
Mailing Address - Phone:319-236-8298
Mailing Address - Fax:319-236-8298
Practice Address - Street 1:3641 KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5757
Practice Address - Country:US
Practice Address - Phone:319-236-8298
Practice Address - Fax:319-236-8298
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0037101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA159256OtherPROVIDER ID COMPSYCH
IA269934OtherPROVIDER ID VALUE OPTIONS