Individual
KATIE L MULALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
353 N 4TH AVE, STE 110, POCATELLO, ID 83201-6390
(208) 233-7832
(208) 236-6695
Mailing address
PO BOX 4908, POCATELLO, ID 83205-4908
(208) 236-1600
(208) 236-6695
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
LPC-5000
ID
Other
Enumeration date
03/10/2010
Last updated
10/11/2012
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