Healthcare Provider Details

I. General information

NPI: 1265091383
Provider Name (Legal Business Name): RAYFORD MULLINS P-LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 BLUECUTT RD STE 201
COLUMBUS MS
39705-1397
US

IV. Provider business mailing address

3600 BLUECUTT RD STE 201
COLUMBUS MS
39705-1397
US

V. Phone/Fax

Practice location:
  • Phone: 662-329-3973
  • Fax: 662-329-9056
Mailing address:
  • Phone: 662-329-3973
  • Fax: 662-329-9056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP-1473
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: