Provider Demographics
NPI:1154394088
Name:MULLINS, JANET R (PSYD)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:R
Last Name:MULLINS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 CATHEDRAL PL STE 407
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-4460
Mailing Address - Country:US
Mailing Address - Phone:904-540-5523
Mailing Address - Fax:904-417-0084
Practice Address - Street 1:24 CATHEDRAL PL STE 407
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-4460
Practice Address - Country:US
Practice Address - Phone:904-540-5523
Practice Address - Fax:904-417-0084
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103T00000X
WAPY00002018103TC0700X
FLPY10069103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist