MEDICARE: DR. MICHAEL E. MULLAN PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY21513	CA

General Provider Information

NPI Number	:	1700078011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL E. MULLAN PSY.D.

Provider Business Mailing Address
First Line	:	1479 W LACEY BLVD
Second Line	:
City	:	HANFORD
State	:	CA
Zip	:	93230-5906
Country	:	US
Telephone Number	:	559-583-4617
Fax Number	:	559-583-4625

Provider Business Practice Location Address
First Line	:	155 S 5TH ST
Second Line	:
City	:	COALINGA
State	:	CA
Zip	:	93210-1903
Country	:	US
Telephone Number	:	559-935-4282
Fax Number	:	559-935-4285

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2007
Last Update Date	:	09/04/2014

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