Healthcare Provider Details

I. General information

NPI: 1386980274
Provider Name (Legal Business Name): HEATHER MICHELLE MULLINS M.A., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER EPPINETTE

II. Dates (important events)

Enumeration Date: 12/20/2012
Last Update Date: 03/16/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KENDALL DR
LAMAR CO
81052-3901
US

IV. Provider business mailing address

711 BARNES AVE
LA JUNTA CO
81050
US

V. Phone/Fax

Practice location:
  • Phone: 719-336-7501
  • Fax: 719-336-7453
Mailing address:
  • Phone: 719-384-5446
  • Fax: 719-384-5672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12500
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: