Provider Demographics
NPI:1376787531
Name:MAULDNG, PHILLIP BARRY (MA)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:BARRY
Last Name:MAULDNG
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17702 33RD PL W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-7717
Mailing Address - Country:US
Mailing Address - Phone:206-234-4373
Mailing Address - Fax:
Practice Address - Street 1:1900 N 175TH ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-5104
Practice Address - Country:US
Practice Address - Phone:206-533-9984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral