Provider Demographics
NPI:1053767558
Name:MCMULLIN, ANGELA (LCSW)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MCMULLIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22312 E BOOT HILL PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT MCDOWELL
Mailing Address - State:AZ
Mailing Address - Zip Code:85264-4109
Mailing Address - Country:US
Mailing Address - Phone:480-202-9545
Mailing Address - Fax:
Practice Address - Street 1:18205 N 51ST AVE STE 109
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1491
Practice Address - Country:US
Practice Address - Phone:480-202-9545
Practice Address - Fax:855-595-2710
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20160106341041C0700X
MO20180432111041C0700X
AZLCSW-185931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical