Provider Demographics
NPI:1215161435
Name:CRISTINA MULLEN PSYCHOTHERAPY, COACHING AND CONSULTING SERVICES LLC
Entity type:Organization
Organization Name:CRISTINA MULLEN PSYCHOTHERAPY, COACHING AND CONSULTING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:RAYE
Authorized Official - Last Name:MULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:206-214-6009
Mailing Address - Street 1:1800 WESTLAKE AVE N STE 304
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-2782
Mailing Address - Country:US
Mailing Address - Phone:206-214-6009
Mailing Address - Fax:
Practice Address - Street 1:1800 WESTLAKE AVE N STE 304
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-2782
Practice Address - Country:US
Practice Address - Phone:206-214-6009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 000041121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty