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General NPI Number Information
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NPI Number | 1295901809
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Entity Type | Organization
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Legal Business Name | MARILYN MULL L.C.S.W. PC
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Dates
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Enumeration Date | 05/03/2008
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Last Update Date | 05/03/2008
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Provider Practice Location Address
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Address Line | 1012 SE OAK AVE 347
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City | ROSEBURG
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State | OR
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Zip | 97470-4985
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Country | US
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Telephone | 541-672-7142
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1516
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City | ROSEBURG
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State | OR
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Zip | 97470-0358
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Country | US
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Telephone | 541-672-7142
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. MARILYN MULL
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Credential | LCSW
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Telephone | 541-672-7142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 1242
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License Number State | OR
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