Basic Information
| Provider Information | |||||||||
| NPI: | 1306336813 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MULLINS | ||||||||
| FirstName: | MARCUS | ||||||||
| MiddleName: | WILLIAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 281 | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982060281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252593191 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2801 LOMBARD AVE | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982013619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252593191 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2018 | ||||||||
| LastUpdateDate: | 05/10/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | CG60149140 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.