Provider Demographics
NPI:1134140692
Name:MULLIN, MARY MARETA (MFT)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:MARETA
Last Name:MULLIN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 ALTARINDA RD
Mailing Address - Street 2:#202
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-2600
Mailing Address - Country:US
Mailing Address - Phone:925-254-6333
Mailing Address - Fax:
Practice Address - Street 1:23 ALTARINDA RD
Practice Address - Street 2:#202
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-2600
Practice Address - Country:US
Practice Address - Phone:925-254-6333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT #7192106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist