MEDICARE: MATT THOMAS MULLENIX

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	101YM0800X	Mental Health Counselor	0701012845	VA

General Provider Information

NPI Number	:	1265217103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATT THOMAS MULLENIX

Provider Business Mailing Address
First Line	:	2577 LOTUS CREEK DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-6450
Country	:	US
Telephone Number	:	757-255-8282
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 COMMONWEALTH PL STE 200-1045
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-4517
Country	:	US
Telephone Number	:	757-255-8282
Fax Number	:

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

Provider Enumeration Date	:	08/29/2023
Last Update Date	:	05/28/2026

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Directions to “ MATT THOMAS MULLENIX ” Practice Location

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