Healthcare Provider Details

I. General information

NPI: 1578183232
Provider Name (Legal Business Name): REBEKAH LYNN MULLENIX BA, IADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 17TH ST SE
CEDAR RAPIDS IA
52403-2610
US

IV. Provider business mailing address

1212 31ST ST NE
CEDAR RAPIDS IA
52402-4020
US

V. Phone/Fax

Practice location:
  • Phone: 319-250-4429
  • Fax:
Mailing address:
  • Phone: 319-420-0047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: