Provider Demographics
NPI:1952855009
Name:MULLIGAN, OLIVIA (BCBA)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:MULLIGAN
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:ROSE
Other - Last Name:MULLIGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA
Mailing Address - Street 1:5281 N 99TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-2209
Mailing Address - Country:US
Mailing Address - Phone:623-263-3966
Mailing Address - Fax:
Practice Address - Street 1:5281 N 99TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85305-2209
Practice Address - Country:US
Practice Address - Phone:623-263-3966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-06
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-20-43497103K00000X
AZ1-20-43497103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst