Healthcare Provider Details

I. General information

NPI: 1699697425
Provider Name (Legal Business Name): MARLO MULLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8557 FALLS CREEK MAIN
DURANGO CO
81301-6999
US

IV. Provider business mailing address

8557 FALLS CREEK MAIN
DURANGO CO
81301-6999
US

V. Phone/Fax

Practice location:
  • Phone: 210-883-8468
  • Fax:
Mailing address:
  • Phone: 210-883-8468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number101580
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: