Individual
JEANNE MULLALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
104 4TH AVE SW, ROOM 238, ALBANY, OR 97321-2804
(541) 967-3819
(541) 967-7259
Mailing address
PO BOX 100, ALBANY, OR 97321-0031
(541) 967-3819
(541) 967-7259
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
2225
OR
1041C0700X
Clinical Social Worker
L2225
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101279
—
OR
Enumeration date
09/07/2016
Last updated
03/04/2019
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