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General NPI Number Information
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NPI Number | 1538398649
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Entity Type | Individual
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Provider Name | BERNADETT MULVENNA LMFT
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Gender | Female
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Dates
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Enumeration Date | 07/09/2009
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Last Update Date | 07/09/2009
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Provider Practice Location Address
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Address Line | 23193 LA CADENA DR SUITE# 104
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-1482
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Country | US
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Telephone | 949-380-1573
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Fax | 949-380-1581
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Provider Business Mailing Address
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Address Line | 327 E 21ST ST # G
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City | COSTA MESA
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State | CA
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Zip | 92627-2186
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Country | US
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Telephone | 949-233-5669
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 45454
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License Number State | CA
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