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NPI Code Detail

MEDICARE: MULLINAX COUNSELING PLLC

MEDICARE: MULLINAX COUNSELING PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
133673OTHERTXLCSW

General Provider Information

NPI Number : 1013613439
Entity Type Code : Organization
Provider Name (Legal Business Name) : MULLINAX COUNSELING PLLC
Provider Business Mailing Address
First Line : 2222 ENCHANTED PARK LN
Second Line :
City : KATY
State : TX
Zip : 77450-7128
Country : US
Telephone Number : 281-639-9180
Fax Number :
Provider Business Practice Location Address
First Line : 16225 PARK TEN PL STE 500
Second Line :
City : HOUSTON
State : TX
Zip : 77084-5152
Country : US
Telephone Number : 281-639-9180
Fax Number :
Authorized Official
Title or Position : SOLE MEMBER
Name : STACI LENAE MULLINAX
Credential : LCSW
Telephone Number : 281-915-9633
Provider Enumeration Date : 02/07/2023
Last Update Date : 04/18/2023

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