MEDICARE: JENNIFER MULLANE

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	101YM0800X	Mental Health Counselor	LPCC329	CA
2	101YP2500X	Professional Counselor	LPC329	CA

General Provider Information

NPI Number	:	1750796439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MULLANE

Provider Business Mailing Address
First Line	:	1516 OAK ST
Second Line	:	SUITE 313
City	:	ALAMEDA
State	:	CA
Zip	:	94501-2947
Country	:	US
Telephone Number	:	510-205-6598
Fax Number	:

Provider Business Practice Location Address
First Line	:	1516 OAK ST
Second Line	:	SUITE 313
City	:	ALAMEDA
State	:	CA
Zip	:	94501-2947
Country	:	US
Telephone Number	:	510-205-6598
Fax Number	:

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

Provider Enumeration Date	:	06/21/2014
Last Update Date	:	12/04/2023

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