Healthcare Provider Details

I. General information

NPI: 1023702065
Provider Name (Legal Business Name): SHERRY L MULLEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 06/05/2023
Certification Date: 06/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2066 W APACHE TRL STE 101
APACHE JUNCTION AZ
85120-3733
US

IV. Provider business mailing address

17418 N 22ND ST
PHOENIX AZ
85022-2233
US

V. Phone/Fax

Practice location:
  • Phone: 602-505-7677
  • Fax:
Mailing address:
  • Phone: 602-505-7767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-21751
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: