MEDICARE: KENECIA MULLER LMHC

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	MH15597	FL

General Provider Information

NPI Number	:	1295291201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENECIA MULLER LMHC

Provider Business Mailing Address
First Line	:	6817 SOUTHPOINT PKWY STE 1203
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-6296
Country	:	US
Telephone Number	:	904-280-7300
Fax Number	:

Provider Business Practice Location Address
First Line	:	6817 SOUTHPOINT PKWY STE 1203
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-6296
Country	:	US
Telephone Number	:	904-280-7300
Fax Number	:

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

Provider Enumeration Date	:	02/14/2019
Last Update Date	:	02/14/2019

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