Healthcare Provider Details

I. General information

NPI: 1609310648
Provider Name (Legal Business Name): JENNIFER L MULLINS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2016
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 S ROAN ST
JOHNSON CITY TN
37601-5728
US

IV. Provider business mailing address

404 S ROAN ST
JOHNSON CITY TN
37601-5728
US

V. Phone/Fax

Practice location:
  • Phone: 423-922-5770
  • Fax:
Mailing address:
  • Phone: 423-922-5770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2201
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133003490
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: