Provider Demographics
NPI:1083770804
Name:THOMAS W. MULDARY, PH.D. AND PATRICIA M. MULDARY, PH.D. PC
Entity Type:Organization
Organization Name:THOMAS W. MULDARY, PH.D. AND PATRICIA M. MULDARY, PH.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MULDARY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:517-263-8113
Mailing Address - Street 1:738 S MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-3787
Mailing Address - Country:US
Mailing Address - Phone:517-263-8113
Mailing Address - Fax:517-265-3070
Practice Address - Street 1:738 S MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-3787
Practice Address - Country:US
Practice Address - Phone:517-263-8113
Practice Address - Fax:517-265-3070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005770103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680D64503OtherBLUE CROSS GROUP PIN