MEDICARE: MR. WALTER ZANE MULLINS CADC

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	101Y00000X	Counselor	247048	KY
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	247048	KY

General Provider Information

NPI Number	:	1861344459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WALTER ZANE MULLINS CADC

Provider Business Mailing Address
First Line	:	PO BOX 1305
Second Line	:
City	:	MANCHESTER
State	:	KY
Zip	:	40962-4305
Country	:	US
Telephone Number	:	606-391-8722
Fax Number	:

Provider Business Practice Location Address
First Line	:	14892 N US HIGHWAY 25 E STE 3
Second Line	:
City	:	CORBIN
State	:	KY
Zip	:	40701-6190
Country	:	US
Telephone Number	:	606-526-9348
Fax Number	:

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

Provider Enumeration Date	:	02/13/2026
Last Update Date	:	02/13/2026

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