Provider Demographics
NPI:1801561790
Name:MULBAH, CHANEL L (MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:CHANEL
Middle Name:L
Last Name:MULBAH
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 WHITES RD APT D2
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-3548
Mailing Address - Country:US
Mailing Address - Phone:610-256-2498
Mailing Address - Fax:
Practice Address - Street 1:319 WHITES RD APT D2
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-3548
Practice Address - Country:US
Practice Address - Phone:610-256-2498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011224101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional