=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013613439
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MULLINAX COUNSELING PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2023
-----------------------------------------------------
Last Update Date | 04/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16225 PARK TEN PL STE 500
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77084-5152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-639-9180
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2222 ENCHANTED PARK LN
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77450-7128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-639-9180
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MEMBER
-----------------------------------------------------
Name | STACI LENAE MULLINAX
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 281-915-9633
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------