Healthcare Provider Details

I. General information

NPI: 1902425390
Provider Name (Legal Business Name): KRIS MULHOLLEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W PLATT ST STE 202
TAMPA FL
33606-2136
US

IV. Provider business mailing address

5124 FALLEN LEAF DR
RIVERVIEW FL
33578-4738
US

V. Phone/Fax

Practice location:
  • Phone: 813-618-3150
  • Fax:
Mailing address:
  • Phone: 813-618-3150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. KRIS REBECCA MULHOLLEN
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential: MA, LMHC
Phone: 813-618-3150