Individual
MARY MULLENBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD, LP
Contact information
Practice address
6550 YORK AVE. S., SUITE 503, MINNEAPOLIS, MN 55435
(952) 426-3034
(612) 540-0460
Mailing address
6550 YORK AVE. S., SUITE 503, MINNEAPOLIS, MN 55435-2336
(952) 426-3034
(612) 540-0460
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP4360
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235351826
—
MN
Enumeration date
05/03/2007
Last updated
09/06/2018
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