Provider Demographics
NPI:1588172530
Name:MULLAN, MARIANNE (MA)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:MULLAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:M
Other - Middle Name:
Other - Last Name:MULLAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:8001 RAVINES EDGE CT STE 201
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-5423
Mailing Address - Country:US
Mailing Address - Phone:614-896-8252
Mailing Address - Fax:
Practice Address - Street 1:8001 RAVINES EDGE CT STE 201
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-5423
Practice Address - Country:US
Practice Address - Phone:614-896-8252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1800496101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health