MEDICARE: JAMES ANTON MULICK PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TM1800X	Intellectual & Developmental Disabilities Psychologist	3431	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0610940	OTHER	OH	BCMH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295759082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES ANTON MULICK PH.D.

Provider Business Mailing Address
First Line	:	700 CHILDRENS DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43205-2664
Country	:	US
Telephone Number	:	614-722-4700
Fax Number	:	614-722-4718

Provider Business Practice Location Address
First Line	:	187 W SCHROCK RD
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-2890
Country	:	US
Telephone Number	:	614-355-8315
Fax Number	:	614-355-8361

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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