Provider Demographics
NPI:1932298635
Name:MULCAHY, TERRA LEE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TERRA
Middle Name:LEE
Last Name:MULCAHY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TERRA
Other - Middle Name:
Other - Last Name:KRULISKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 90921
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91109-0921
Mailing Address - Country:US
Mailing Address - Phone:626-688-1278
Mailing Address - Fax:
Practice Address - Street 1:11388 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1605
Practice Address - Country:US
Practice Address - Phone:310-268-2541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS6845101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health