Healthcare Provider Details

I. General information

NPI: 1033247564
Provider Name (Legal Business Name): ANN STEPHANIE HRYSHKO-MULLEN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WILFORD HALL LOOP, BLDG 4554 ATTN CREDENTIALS (CMC)
JBSA-LACKLAND TX
78236-5638
US

IV. Provider business mailing address

1100 WILFORD HALL LOOP, BLDG 4554 ATTN CREDENTIALS (CMC)
JBSA-LACKLAND TX
78236-5638
US

V. Phone/Fax

Practice location:
  • Phone: 210-292-5968
  • Fax: 210-292-5356
Mailing address:
  • Phone: 210-292-5968
  • Fax: 210-292-5356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number756
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: