MEDICARE: JENNA MARIE MULLINAX

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	103K00000X	Behavior Analyst	3179	TX

General Provider Information

NPI Number	:	1104465202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA MARIE MULLINAX

Provider Business Mailing Address
First Line	:	6008 CENTER ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-3007
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1155 BRITTMOORE RD STE A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043-5034
Country	:	US
Telephone Number	:	713-932-0074
Fax Number	:

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

Provider Enumeration Date	:	01/06/2020
Last Update Date	:	01/06/2020

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Directions to “ JENNA MARIE MULLINAX ” Practice Location

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