MEDICARE: DR. AMAL ABUZALAF MULL PSY.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	103TC0700X	Clinical Psychologist	PY60650485	WA

General Provider Information

NPI Number	:	1598196305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMAL ABUZALAF MULL PSY.D.

Provider Business Mailing Address
First Line	:	PO BOX 285
Second Line	:
City	:	ELLENSBURG
State	:	WA
Zip	:	98926-1912
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1206 N DOLARWAY RD STE 217
Second Line	:
City	:	ELLENSBURG
State	:	WA
Zip	:	98926-8392
Country	:	US
Telephone Number	:	509-289-4077
Fax Number	:	509-591-9600

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

Provider Enumeration Date	:	12/04/2013
Last Update Date	:	04/10/2021

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