Basic Information
| Provider Information | |||||||||
| NPI: | 1356884233 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MULCAHY | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15127 S 73RD AVE | ||||||||
| Address2: | SUITE G | ||||||||
| City: | ORLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604624398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7088455500 | ||||||||
| FaxNumber: | 7088455505 | ||||||||
| Practice Location | |||||||||
| Address1: | 962 W US HIGHWAY 30 | ||||||||
| Address2: | UNIT 8 | ||||||||
| City: | SCHERERVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463751551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7088455500 | ||||||||
| FaxNumber: | 7088455505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2016 | ||||||||
| LastUpdateDate: | 12/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 150.101989 | IL | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 149.021500 | IL | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 34008654A | IN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.