Provider Demographics
NPI:1265605950
Name:MULVEY, MIGNON (PHD)
Entity type:Individual
Prefix:
First Name:MIGNON
Middle Name:
Last Name:MULVEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MIGNON
Other - Middle Name:
Other - Last Name:JAMBON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 833462
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75083-3462
Mailing Address - Country:US
Mailing Address - Phone:985-677-0108
Mailing Address - Fax:
Practice Address - Street 1:1125 E RENNER RD APT 1104A
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-2144
Practice Address - Country:US
Practice Address - Phone:985-677-0108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA10187OtherSTATE