Individual
SHATAE MULLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1031 W SANETTA ST, NAMPA, ID 83651-5047
(208) 466-7443
Mailing address
1031 W SANETTA ST, NAMPA, ID 83651-5047
(208) 466-7443
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-7798
ID
Other
Enumeration date
08/06/2020
Last updated
08/06/2020
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