Provider Demographics
NPI:1144386996
Name:MULDARY, THOMAS (PHD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:MULDARY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005130103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680D64503OtherBLUE CROSS GROUP PIN
MI680D64506OtherBLUE CROSS PIN