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General NPI Number Information
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NPI Number | 1295166270
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Entity Type | Organization
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Legal Business Name | CAROL MULLIGAN MSLLC
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Dates
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Enumeration Date | 12/02/2013
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Last Update Date | 12/02/2013
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Provider Practice Location Address
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Address Line | 1227 N 23RD ST 103
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-6565
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Country | US
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Telephone | 970-549-1624
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Fax | 970-549-1626
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Provider Business Mailing Address
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Address Line | 1227 N 23RD ST 103
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-6565
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Country | US
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Telephone | 970-549-1624
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Fax | 970-549-1626
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | CAROL ANNE MULLIGAN
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Credential | MSCACIII
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Telephone | 970-549-1624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 4626
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License Number State | CO
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