Provider Demographics
NPI:1194083873
Name:MULLEN, KELLY KAREN (MS)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:KAREN
Last Name:MULLEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 GLENCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-1717
Mailing Address - Country:US
Mailing Address - Phone:412-864-5115
Mailing Address - Fax:
Practice Address - Street 1:333 N BRADDOCK AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15208-2512
Practice Address - Country:US
Practice Address - Phone:412-864-5115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health