Healthcare Provider Details

I. General information

NPI: 1831281690
Provider Name (Legal Business Name): AMY MELISSA MULHOLLAND PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6150 DIAMOND CENTRE CT UNIT 1003
FORT MYERS FL
33912-7135
US

IV. Provider business mailing address

6150 DIAMOND CENTRE CT UNIT 1003
FORT MYERS FL
33912-7135
US

V. Phone/Fax

Practice location:
  • Phone: 239-561-9955
  • Fax: 239-561-9779
Mailing address:
  • Phone: 239-561-9955
  • Fax: 239-561-9779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY6605
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: