Healthcare Provider Details

I. General information

NPI: 1992659940
Provider Name (Legal Business Name): HEATHER MCMULLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 E MAIN ST
NEWARK OH
43055-5651
US

IV. Provider business mailing address

2727 S 3RD ST
IRONTON OH
45638-2760
US

V. Phone/Fax

Practice location:
  • Phone: 740-534-2939
  • Fax: 877-384-2939
Mailing address:
  • Phone: 740-534-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCAPRE.197168
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.007026
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: