Provider Demographics
NPI:1831281690
Name:MULHOLLAND, AMY MELISSA (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:MELISSA
Last Name:MULHOLLAND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6150 DIAMOND CENTRE CT UNIT 1003
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-7135
Mailing Address - Country:US
Mailing Address - Phone:239-561-9955
Mailing Address - Fax:239-561-9779
Practice Address - Street 1:6150 DIAMOND CENTRE CT UNIT 1003
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-7135
Practice Address - Country:US
Practice Address - Phone:239-561-9955
Practice Address - Fax:239-561-9779
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6605103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54869OtherBCBS OF FL IND.PROVIDER #
FL74976OtherBCBS OF FL GROUP PRACTICE