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General NPI Number Information
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NPI Number | 1003066887
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Entity Type | Individual
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Provider Name | CRYSTAL ANN MCMULLEN
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Gender | Female
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Dates
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Enumeration Date | 09/29/2008
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Last Update Date | 09/29/2008
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Provider Practice Location Address
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Address Line | 5918 LEE AVE
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City | LITTLE ROCK
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State | AR
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Zip | 72205-3326
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Country | US
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Telephone | 501-669-2199
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Fax |
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Provider Business Mailing Address
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Address Line | 74 WRIGHT CIR
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City | JACKSONVILLE
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State | AR
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Zip | 72076-5043
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Country | US
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Telephone | 501-613-2989
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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