Basic Information
| Provider Information | |||||||||
| NPI: | 1578721734 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MULLARD | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.A., M.F.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23228 MADERO | ||||||||
| Address2: | |||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9494543940 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 23228 MADERO | ||||||||
| Address2: | |||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926912706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9494543940 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2008 | ||||||||
| LastUpdateDate: | 07/01/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | N | Behavioral Health & Social Service Providers | Psychologist | 106H00000X | MFC36587 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.