Healthcare Provider Details

I. General information

NPI: 1902113731
Provider Name (Legal Business Name): SARAH MULLIKIN LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 DON PASQUAL RD NW
LOS LUNAS NM
87031-8493
US

IV. Provider business mailing address

PO BOX 518
LOS LUNAS NM
87031-0518
US

V. Phone/Fax

Practice location:
  • Phone: 505-865-3350
  • Fax: 505-865-4739
Mailing address:
  • Phone: 505-865-3350
  • Fax: 505-865-4739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT0125051
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: