Provider Demographics
NPI:1750016135
Name:MULLIGAN, MEGHAN KELSEA (LMHC)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:KELSEA
Last Name:MULLIGAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CARILLON PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1108
Mailing Address - Country:US
Mailing Address - Phone:727-519-2760
Mailing Address - Fax:727-333-6384
Practice Address - Street 1:900 CARILLON PKWY STE 200
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1108
Practice Address - Country:US
Practice Address - Phone:727-519-2760
Practice Address - Fax:727-333-6384
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH20995101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health