Provider Demographics
NPI:1740893643
Name:MULLAN, BRIAN PAUL
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:PAUL
Last Name:MULLAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 E LA CROSSE AVE APT B
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-2002
Mailing Address - Country:US
Mailing Address - Phone:484-410-1127
Mailing Address - Fax:
Practice Address - Street 1:31 E LA CROSSE AVE APT B
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-2002
Practice Address - Country:US
Practice Address - Phone:484-410-1127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012598101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional