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General NPI Number Information
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NPI Number | 1750744496
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Entity Type | Individual
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Provider Name | JENNIFER REINOVSKY MULLETT
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Gender | Female
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Dates
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Enumeration Date | 03/31/2016
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Last Update Date | 11/19/2021
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Provider Practice Location Address
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Address Line | 10 PATEWOOD DR STE 130
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City | GREENVILLE
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State | SC
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Zip | 29615-6317
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Country | US
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Telephone | 864-455-8988
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Fax | 864-455-4540
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Provider Business Mailing Address
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Address Line | 300 E MCBEE AVE STE 401
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City | GREENVILLE
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State | SC
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Zip | 29601-2842
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Country | US
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Telephone | 864-522-8602
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 83342
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License Number State | SC
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