Healthcare Provider Details

I. General information

NPI: 1114187267
Provider Name (Legal Business Name): EDWARD DAVID MULLIGAN III LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 FLORIDA STREET BLDG 200, SUITE 226
MANDEVILLE LA
70448
US

IV. Provider business mailing address

1901 HIGHWAY 190 APT 1323
MANDEVILLE LA
70448-3486
US

V. Phone/Fax

Practice location:
  • Phone: 985-774-0175
  • Fax: 985-377-0980
Mailing address:
  • Phone: 985-774-0175
  • Fax: 985-377-0980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6610
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: