Healthcare Provider Details

I. General information

NPI: 1033758818
Provider Name (Legal Business Name): PATRICK MCMULLEN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2019
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HAZEL LN STE 300
SEWICKLEY PA
15143-1253
US

IV. Provider business mailing address

1768 S CANAL ST
PITTSBURGH PA
15215-2640
US

V. Phone/Fax

Practice location:
  • Phone: 412-749-7330
  • Fax:
Mailing address:
  • Phone: 717-357-4806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierPC014105
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerSTATE LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: