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General NPI Number Information
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NPI Number | 1134345374
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Entity Type | Individual
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Provider Name | PEG A, MCMULLEN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7396 PERSHING AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63130-4206
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Country | US
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Telephone | 618-304-3989
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Fax |
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Provider Business Mailing Address
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Address Line | 23 SUGAR LN
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City | COLLINSVILLE
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State | IL
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Zip | 62234-6811
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Country | US
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Telephone | 618-344-9155
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 00984
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License Number State | MO
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