Provider Demographics
NPI:1538398649
Name:MULVENNA, BERNADETT (LMFT)
Entity type:Individual
Prefix:MS
First Name:BERNADETT
Middle Name:
Last Name:MULVENNA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 E 21ST ST
Mailing Address - Street 2:# G
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2186
Mailing Address - Country:US
Mailing Address - Phone:949-233-5669
Mailing Address - Fax:
Practice Address - Street 1:23193 LA CADENA DR
Practice Address - Street 2:SUITE# 104
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1482
Practice Address - Country:US
Practice Address - Phone:949-380-1573
Practice Address - Fax:949-380-1581
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45454106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist