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General NPI Number Information
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NPI Number | 1902425390
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Entity Type | Organization
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Legal Business Name | KRIS MULHOLLEN LLC
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Dates
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Enumeration Date | 04/15/2020
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Last Update Date | 04/15/2020
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Provider Practice Location Address
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Address Line | 1200 W PLATT ST STE 202
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City | TAMPA
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State | FL
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Zip | 33606-2136
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Country | US
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Telephone | 813-618-3150
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Fax |
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Provider Business Mailing Address
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Address Line | 5124 FALLEN LEAF DR
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City | RIVERVIEW
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State | FL
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Zip | 33578-4738
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Country | US
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Telephone | 813-618-3150
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Fax |
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Authorized Official
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Title or Position | LICENSED MENTAL HEALTH COUNSELOR
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Name | MRS. KRIS REBECCA MULHOLLEN
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Credential | MA, LMHC
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Telephone | 813-618-3150
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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