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General NPI Number Information
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NPI Number | 1942561741
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Entity Type | Individual
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Provider Name | CHRISTOPHER MULLIGAN LCSW
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Gender | Male
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Dates
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Enumeration Date | 06/07/2012
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Last Update Date | 06/07/2012
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Provider Practice Location Address
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Address Line | 3685 MOTOR AVE SUITE 150
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City | LOS ANGELES
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State | CA
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Zip | 90034-5750
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Country | US
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Telephone | 310-287-1640
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Fax | 310-287-0851
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Provider Business Mailing Address
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Address Line | 3685 MOTOR AVE STE 150
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City | LOS ANGELES
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State | CA
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Zip | 90034-7203
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Country | US
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Telephone | 310-287-1640
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Fax | 310-287-0851
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | LCS18188
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License Number State | CA
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