Provider Demographics
NPI:1134751159
Name:MULLANEY, SAMARA ANNA (LMHC)
Entity type:Individual
Prefix:MRS
First Name:SAMARA
Middle Name:ANNA
Last Name:MULLANEY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:SAMARA
Other - Middle Name:
Other - Last Name:CANDREVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9250 COLUMBIA AVE STE 2E
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3530
Mailing Address - Country:US
Mailing Address - Phone:219-595-0043
Mailing Address - Fax:219-237-2894
Practice Address - Street 1:9250 COLUMBIA AVE STE 2E
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3530
Practice Address - Country:US
Practice Address - Phone:219-595-0043
Practice Address - Fax:219-237-2894
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003736A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health