Healthcare Provider Details

I. General information

NPI: 1295759082
Provider Name (Legal Business Name): JAMES ANTON MULICK PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 W SCHROCK RD
WESTERVILLE OH
43081-2890
US

IV. Provider business mailing address

700 CHILDRENS DR
COLUMBUS OH
43205-2664
US

V. Phone/Fax

Practice location:
  • Phone: 614-355-8315
  • Fax: 614-355-8361
Mailing address:
  • Phone: 614-722-4700
  • Fax: 614-722-4718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number3431
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: