Provider Demographics
NPI:1316611387
Name:MULLIS, TORI GRACE (LICENSURE)
Entity type:Individual
Prefix:
First Name:TORI
Middle Name:GRACE
Last Name:MULLIS
Suffix:
Gender:F
Credentials:LICENSURE
Other - Prefix:
Other - First Name:TORIGRACE
Other - Middle Name:
Other - Last Name:MULLIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:200 TECH CENTER DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37912-2747
Mailing Address - Country:US
Mailing Address - Phone:865-637-9711
Mailing Address - Fax:
Practice Address - Street 1:1105 OAK CLUSTER DR
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-6079
Practice Address - Country:US
Practice Address - Phone:865-429-0557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health