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General NPI Number Information
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NPI Number | 1104137389
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Entity Type | Individual
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Provider Name | HERMAN THOMAS MULLIS PHD, LPC, LMFT
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Gender | Male
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Dates
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Enumeration Date | 06/23/2010
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Last Update Date | 06/23/2010
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Provider Practice Location Address
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Address Line | 1999 S MAIN ST SUITE J
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City | BLACKSBURG
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State | VA
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Zip | 24060-6634
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Country | US
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Telephone | 540-818-0566
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Fax |
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Provider Business Mailing Address
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Address Line | 290 MOYE RD
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City | STAFFORDSVILLE
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State | VA
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Zip | 24167-3530
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Country | US
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Telephone | 540-818-0566
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701000211
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0717000606
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License Number State | VA
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