Provider Demographics
NPI:1043100738
Name:MULLIS, COURTNEY (BCBA)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:MULLIS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 THE PRESERVE DR UNIT 1012
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-8426
Mailing Address - Country:US
Mailing Address - Phone:770-670-9306
Mailing Address - Fax:
Practice Address - Street 1:1550 N BROWN RD STE 100
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-8155
Practice Address - Country:US
Practice Address - Phone:404-905-1424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-25-82448103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst