MEDICARE: MS. EMILY SHIREY MULLEN LPC

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	ALC05046	AL

General Provider Information

NPI Number	:	1396564639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EMILY SHIREY MULLEN LPC

Provider Business Mailing Address
First Line	:	2101 OWEN DR NE
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967-7678
Country	:	US
Telephone Number	:	256-630-5050
Fax Number	:

Provider Business Practice Location Address
First Line	:	1303 GAULT AVE N STE 1A
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967-3108
Country	:	US
Telephone Number	:	256-630-5050
Fax Number	:

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

Provider Enumeration Date	:	10/03/2024
Last Update Date	:	03/24/2026

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