MEDICARE: DR. BREE MARIE MULLIN PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PY0677	NV
2	103TC2200X	Clinical Child & Adolescent Psychologist	PY0677	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073687166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BREE MARIE MULLIN PSY.D.

Provider Business Mailing Address
First Line	:	3175 E WARM SPRINGS RD STE 105
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3137
Country	:	US
Telephone Number	:	702-506-4089
Fax Number	:

Provider Business Practice Location Address
First Line	:	3175 E WARM SPRINGS RD STE 105
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3137
Country	:	US
Telephone Number	:	702-506-4089
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	10/02/2023

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