Provider Demographics
NPI:1376193318
Name:MULLEN, VANESSA (AMFT)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:MULLEN
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:CUSHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:41555 COOK ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-5184
Mailing Address - Country:US
Mailing Address - Phone:760-837-0033
Mailing Address - Fax:
Practice Address - Street 1:41555 COOK ST STE 100
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-5184
Practice Address - Country:US
Practice Address - Phone:760-837-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA113814106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist