Provider Demographics
NPI:1841602448
Name:MULLEN, NICOLE PAULINE (LPC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:PAULINE
Last Name:MULLEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 S ELMER AVE STE 116
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-2400
Mailing Address - Country:US
Mailing Address - Phone:570-867-0771
Mailing Address - Fax:
Practice Address - Street 1:703 S ELMER AVE STE 116
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-2400
Practice Address - Country:US
Practice Address - Phone:570-867-0771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-30
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007611101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty