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Organization
MULLIGAN'S MANOR, INC.
Active
Organization
MULLIGAN'S MANOR, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER SAMAYOA DIAZ LCSW (EXECUTIVE DIRECTOR)
(480) 831-8727
Entity
Organization
Contact information
Practice address
4701 S LAKESHORE DR UNIT 1, TEMPE, AZ 85282-7169
(480) 831-8721
(480) 272-8708
Mailing address
4701 S LAKESHORE DR UNIT 1, TEMPE, AZ 85282-7169
(480) 831-8721
(480) 272-8708
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
NULL
101YM0800X
Mental Health Counselor
Primary
—
—
261QC1500X
Community Health Clinic/Center
—
NULL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
NULL
Other
Enumeration date
07/30/2018
Last updated
07/30/2018
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