Healthcare Provider Details

I. General information

NPI: 1609955657
Provider Name (Legal Business Name): PATRICK SEAN MULICK PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 12/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2397 HARRISON ST SUITE C
BATESVILLE AR
72501-7420
US

IV. Provider business mailing address

2230 HARRISON ST
BATESVILLE AR
72501-7417
US

V. Phone/Fax

Practice location:
  • Phone: 870-262-1357
  • Fax: 870-698-0109
Mailing address:
  • Phone: 870-698-2100
  • Fax: 870-698-0109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY 3413
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0806P
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: