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General NPI Number Information
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NPI Number | 1023164472
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Entity Type | Individual
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Provider Name | MARY ANN MULLEN-TIRAS M.F.T.
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Gender | Female
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 10/26/2018
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Provider Practice Location Address
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Address Line | 190 N WIGET LN STE 275
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City | WALNUT CREEK
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State | CA
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Zip | 94598-5922
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Country | US
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Telephone | 925-330-7840
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Fax | 925-944-5544
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Provider Business Mailing Address
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Address Line | 190 N WIGET LN STE 275
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City | WALNUT CREEK
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State | CA
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Zip | 94598-5922
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Country | US
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Telephone | 925-330-7840
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Fax | 925-944-5544
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC43250
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License Number State | CA
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