Provider Demographics
NPI:1366250151
Name:MULUMBA, MARIANNE K
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:K
Last Name:MULUMBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 STATE HIGHWAY 121 APT 1427
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-6036
Mailing Address - Country:US
Mailing Address - Phone:469-490-0924
Mailing Address - Fax:
Practice Address - Street 1:4601 OLD SHEPARD PL STE 404
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5277
Practice Address - Country:US
Practice Address - Phone:469-502-8743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-25
Last Update Date:2024-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist