Provider Demographics
NPI:1407978455
Name:MCNULTY, BRIAN ROBERT (LPC-S)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:ROBERT
Last Name:MCNULTY
Suffix:
Gender:M
Credentials:LPC-S
Other - Prefix:
Other - First Name:BRIAN
Other - Middle Name:ROBERT
Other - Last Name:MCNULTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:706 KIMBERLY ANN CIR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-6732
Mailing Address - Country:US
Mailing Address - Phone:504-931-8294
Mailing Address - Fax:
Practice Address - Street 1:706 KIMBERLY ANN CIR
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-6732
Practice Address - Country:US
Practice Address - Phone:504-931-8294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2346101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional