# MULLIGAN'S MANOR, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427536770
- **Authorized official:** JENNIFER SAMAYOA DIAZ LCSW (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (480) 831-8727

## Contact information

- **Practice address:** 4701 S LAKESHORE DR UNIT 1, TEMPE, AZ 85282-7169
- **Practice address phone:** (480) 831-8721
- **Practice address fax:** (480) 272-8708
- **Mailing address:** 4701 S LAKESHORE DR UNIT 1, TEMPE, AZ 85282-7169
- **Mailing address phone:** (480) 831-8721
- **Mailing address fax:** (480) 272-8708

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |
| 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