MEDICARE: KIMBERLY ANN MULKEY LMFT

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	106H00000X	Marriage & Family Therapist	MFT001847	GA

General Provider Information

NPI Number	:	1598345191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ANN MULKEY LMFT

Provider Business Mailing Address
First Line	:	5975 PARKWAY NORTH BLVD STE D
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-8255
Country	:	US
Telephone Number	:	404-388-3909
Fax Number	:	678-712-1945

Provider Business Practice Location Address
First Line	:	5975 PARKWAY NORTH BLVD STE D
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-8255
Country	:	US
Telephone Number	:	404-388-3909
Fax Number	:	678-712-1945

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

Provider Enumeration Date	:	04/09/2021
Last Update Date	:	04/09/2021

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Directions to “ KIMBERLY ANN MULKEY LMFT” Practice Location

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