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NPI Code Detail

MEDICARE: IRENE MULLENIX MA, PCC

MEDICARE:   IRENE  MULLENIX  MA, PCC
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
1101YP2500XProfessional CounselorC. 0500926OH

General Provider Information

NPI Number : 1811179484
Entity Type Code : Individual
Provider Name (Legal Business Name) : IRENE MULLENIX MA, PCC
Provider Business Mailing Address
First Line : 2085 MECCA RD
Second Line : LIGHTHOUSE COUNSELING SERVICES
City : COLUMBUS
State : OH
Zip : 43224-4512
Country : US
Telephone Number : 614-337-1986
Fax Number :
Provider Business Practice Location Address
First Line : 2085 MECCA RD
Second Line : LIGHTHOUSE COUNSELING SERVICES
City : COLUMBUS
State : OH
Zip : 43224-4512
Country : US
Telephone Number : 614-337-1986
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2007
Last Update Date : 01/14/2011

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