Provider Demographics
NPI:1295166270
Name:CAROL MULLIGAN MSLLC
Entity type:Organization
Organization Name:CAROL MULLIGAN MSLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MULLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSCACIII
Authorized Official - Phone:970-549-1624
Mailing Address - Street 1:1227 N 23RD ST
Mailing Address - Street 2:103
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-6565
Mailing Address - Country:US
Mailing Address - Phone:970-549-1624
Mailing Address - Fax:970-549-1626
Practice Address - Street 1:1227 N 23RD ST
Practice Address - Street 2:103
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6565
Practice Address - Country:US
Practice Address - Phone:970-549-1624
Practice Address - Fax:970-549-1626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4626101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty