Provider Demographics
NPI:1346716560
Name:MULLIGAN, KELLY (MA, LMHCA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MULLIGAN
Suffix:
Gender:F
Credentials:MA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-3339
Mailing Address - Country:US
Mailing Address - Phone:206-818-4645
Mailing Address - Fax:
Practice Address - Street 1:2808 E MADISON ST STE 206
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4867
Practice Address - Country:US
Practice Address - Phone:206-818-4645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60905102101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health