Provider Demographics
NPI:1962962696
Name:DR. JANET R. MULLINS, PSYCHOLOGIST, LLC
Entity type:Organization
Organization Name:DR. JANET R. MULLINS, PSYCHOLOGIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:R
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:904-540-5523
Mailing Address - Street 1:24 CATHEDRAL PL STE 407
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-4460
Mailing Address - Country:US
Mailing Address - Phone:904-540-5523
Mailing Address - Fax:
Practice Address - Street 1:24 CATHEDRAL PL STE 407
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-4460
Practice Address - Country:US
Practice Address - Phone:904-540-5523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)