Provider Demographics
NPI:1457637563
Name:MULKEY, ALPATRICIA (QBA)
Entity Type:Individual
Prefix:
First Name:ALPATRICIA
Middle Name:
Last Name:MULKEY
Suffix:
Gender:F
Credentials:QBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 SHERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-1362
Mailing Address - Country:US
Mailing Address - Phone:702-644-4195
Mailing Address - Fax:702-644-2519
Practice Address - Street 1:2630 SHERWOOD ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-1362
Practice Address - Country:US
Practice Address - Phone:702-644-4195
Practice Address - Fax:702-644-2519
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV76708101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV76708OtherMEDICAID