Mary M Mullally
Counselor (Addiction (Substance Use Disorder))

Address: 2125 W Palmaire Ave, Phoenix, AZ 85021-7742
Phone: 6026473555

Mary M Mullally (NPI# 1861037772) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider Identifier (NPI) 1861037772
Entity Type Individual
Full Name Mary M Mullally
Credential LISAC, LPC
Gender Female
Practice Address 2125 W Palmaire Ave
Phoenix
AZ 85021-7742
Practice Telephone 6026473555
Mailing Address 2125 W Palmaire Ave
Phoenix
AZ 85021-7742
Mailing Telephone 6026473555
Sole Proprietor No, this individual is not a Sole Proprietor
Enumeration Date 2019-11-14
Last Update Date 2019-11-14

Taxonomy Codes

Primary Taxonomy Classification Taxonomy Group License Number State
No 101YP2500X Counselor · Professional Behavioral Health & Social Service Providers 2446 AZ
Yes 101YA0400X Counselor · Addiction (Substance Use Disorder) Behavioral Health & Social Service Providers 0587 AZ

Taxonomy Information

Taxonomy Code 101YA0400X
Grouping Behavioral Health & Social Service Providers
Classification Counselor
Specialization Addiction (Substance Use Disorder)

Taxonomy Definition

Definition to come...

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Office Location

Street Address 2125 W PALMAIRE AVE
City PHOENIX
State AZ
Zip Code 85021-7742

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1568980779 Marla Jean Clay Licensed Practical Nurse 1717 W. Glendale Ave. Apt. 3011, Phoenix, AZ 85021 2017-09-07
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Competitor

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City PHOENIX
Zip Code 85021

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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