Provider Demographics
NPI:1164729349
Name:MULHOLLAND, LAUREL CHRISTA (LSW)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:CHRISTA
Last Name:MULHOLLAND
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 MANHATTAN DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-4254
Mailing Address - Country:US
Mailing Address - Phone:720-224-3722
Mailing Address - Fax:
Practice Address - Street 1:75 MANHATTAN DR
Practice Address - Street 2:SUITE 208
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-4254
Practice Address - Country:US
Practice Address - Phone:720-224-3722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical