Provider Demographics
NPI:1881190858
Name:MCMULLEN, CECILIA (LMT)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:
Last Name:MCMULLEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19184 DR JOHN LAMBERT DR STE 105
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-0936
Mailing Address - Country:US
Mailing Address - Phone:985-549-1900
Mailing Address - Fax:985-549-1888
Practice Address - Street 1:19184 DR JOHN LAMBERT DR STE 105
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-0936
Practice Address - Country:US
Practice Address - Phone:985-549-1900
Practice Address - Fax:985-549-1888
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA8818225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist