Healthcare Provider Details

I. General information

NPI: 1659990968
Provider Name (Legal Business Name): ANGELA MULLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA LESTER

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

767 MAIN ST
WEST LIBERTY KY
41472-1019
US

IV. Provider business mailing address

PO BOX 790
ASHLAND KY
41105-0790
US

V. Phone/Fax

Practice location:
  • Phone: 668-233-1955
  • Fax: 606-743-4336
Mailing address:
  • Phone: 606-329-8588
  • Fax: 606-329-8195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number308898
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: