Provider Demographics
NPI:1689007288
Name:MULLAN, PAUL JAMES (BCBA, CCC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:JAMES
Last Name:MULLAN
Suffix:
Gender:M
Credentials:BCBA, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12619 100TH LN NE
Mailing Address - Street 2:UNIT I-143
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-2868
Mailing Address - Country:US
Mailing Address - Phone:425-218-5799
Mailing Address - Fax:
Practice Address - Street 1:12619 100TH LANE NE
Practice Address - Street 2:I-143
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034
Practice Address - Country:US
Practice Address - Phone:425-218-5799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL60313566101YM0800X
WA1-11-8982103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health