Provider Demographics
NPI:1588080279
Name:MULLINS, TIMOTHY (MA)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:MULLINS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4485 N EAGLE CIR
Mailing Address - Street 2:
Mailing Address - City:RIMROCK
Mailing Address - State:AZ
Mailing Address - Zip Code:86335-5136
Mailing Address - Country:US
Mailing Address - Phone:928-300-0071
Mailing Address - Fax:
Practice Address - Street 1:4485 N EAGLE CIR
Practice Address - Street 2:
Practice Address - City:RIMROCK
Practice Address - State:AZ
Practice Address - Zip Code:86335-5136
Practice Address - Country:US
Practice Address - Phone:928-300-0071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-05
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8511927-6010101YM0800X
AZ18173101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health