Provider Demographics
NPI:1316538978
Name:MULGREW, CHARLOTTE
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:MULGREW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 BOTHAM JEAN BLVD APT 416
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75215-6805
Mailing Address - Country:US
Mailing Address - Phone:469-202-0270
Mailing Address - Fax:469-214-2688
Practice Address - Street 1:1409 BOTHAM JEAN BLVD APT 416
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75215-6805
Practice Address - Country:US
Practice Address - Phone:469-202-0270
Practice Address - Fax:469-214-2688
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81690101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional