Provider Demographics
NPI:1154995520
Name:MULLINS, GRACE (LMFT)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:MULLINS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:MULLINS
Other - Last Name:SELF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:415 W POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6743
Mailing Address - Country:US
Mailing Address - Phone:615-815-5189
Mailing Address - Fax:
Practice Address - Street 1:2021 21ST AVE S STE 410
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-4350
Practice Address - Country:US
Practice Address - Phone:615-815-5189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1596106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist