Provider Demographics
NPI:1396767976
Name:MULVANEY, DALLAS E (PHD, HSPP)
Entity type:Individual
Prefix:
First Name:DALLAS
Middle Name:E
Last Name:MULVANEY
Suffix:
Gender:M
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 WILLOWBROOK PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-1548
Mailing Address - Country:US
Mailing Address - Phone:317-254-0435
Mailing Address - Fax:317-252-2622
Practice Address - Street 1:2506 WILLOWBROOK PKWY STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-1548
Practice Address - Country:US
Practice Address - Phone:317-254-0435
Practice Address - Fax:317-252-2622
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040892A103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral