Basic Information
| Provider Information | |||||||||
| NPI: | 1386001758 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MULDER | ||||||||
| FirstName: | DEBBIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 OXNARD ST. | ||||||||
| Address2: | SUITE 1800 | ||||||||
| City: | WOODLAND HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183452345 | ||||||||
| FaxNumber: | 8184490994 | ||||||||
| Practice Location | |||||||||
| Address1: | 2400 WEST DUNLAP AVE. | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023252485 | ||||||||
| FaxNumber: | 6022252485 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2016 | ||||||||
| LastUpdateDate: | 01/15/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-15-19815 | AZ | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.