Healthcare Provider Details

I. General information

NPI: 1073687166
Provider Name (Legal Business Name): BREE MARIE MULLIN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3175 E WARM SPRINGS RD STE 105
LAS VEGAS NV
89120-3137
US

IV. Provider business mailing address

3175 E WARM SPRINGS RD STE 105
LAS VEGAS NV
89120-3137
US

V. Phone/Fax

Practice location:
  • Phone: 702-506-4089
  • Fax:
Mailing address:
  • Phone: 702-506-4089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY0677
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY0677
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: