Basic Information
| Provider Information | |||||||||
| NPI: | 1245418425 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCMULLEN | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | KAY | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CSW INTERN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KORF | ||||||||
| OtherFirstName: | STEPHANIE | ||||||||
| OtherMiddleName: | KAY | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LSW, MSW | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7475 LA COSTA ST | ||||||||
| Address2: | |||||||||
| City: | SPARKS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894366425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757708505 | ||||||||
| FaxNumber: | 7753343022 | ||||||||
| Practice Location | |||||||||
| Address1: | 745 W MOANA LN | ||||||||
| Address2: | SUITE #100 | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895094932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7753343033 | ||||||||
| FaxNumber: | 7753343022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2008 | ||||||||
| LastUpdateDate: | 03/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 4655-S | NV | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | IC987 | NV | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.