Provider Demographics
NPI:1750889713
Name:MULLETT, ELIZABETH ANN (LPC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:MULLETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 DAWNLIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43211-1934
Mailing Address - Country:US
Mailing Address - Phone:614-471-2626
Mailing Address - Fax:
Practice Address - Street 1:2440 DAWNLIGHT AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43211-1934
Practice Address - Country:US
Practice Address - Phone:614-471-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHC.1801013101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHC.1801013OtherLICENSED PROFESSIONAL COUNSELOR