1396181491 NPI number — HANNAH KATHRYN MCMULLEN LCSW

Table of content: HANNAH KATHRYN MCMULLEN LCSW (NPI 1396181491)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396181491 NPI number — HANNAH KATHRYN MCMULLEN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCMULLEN
Provider First Name:
HANNAH
Provider Middle Name:
KATHRYN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396181491
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
905 MCAFEE MEDICAL CIRCLE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEEBE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72012-2217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-232-2600
Provider Business Mailing Address Fax Number:
501-242-0820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 EAST BEEBE CAPPS EXPRESSWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEARCY
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-232-2600
Provider Business Practice Location Address Fax Number:
501-242-0820
Provider Enumeration Date:
05/15/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  7524-M , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 7524C , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 196886795 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".