Provider Demographics
NPI:1205180957
Name:GARCIA MULLIGAN, PATRICIA ELENA (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ELENA
Last Name:GARCIA MULLIGAN
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ELENA
Other - Last Name:GARCIA, TORREZ, RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:314 TRACY AVE N
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-5169
Mailing Address - Country:US
Mailing Address - Phone:360-443-0743
Mailing Address - Fax:603-925-3391
Practice Address - Street 1:2528 WHEATON WAY STE 204
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3305
Practice Address - Country:US
Practice Address - Phone:360-443-0743
Practice Address - Fax:360-925-3391
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-02
Last Update Date:2024-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60243595101YM0800X, 101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2066848Medicaid