Individual
THOMAS EVAN MULLALY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSS
Contact information
Practice address
411 N GRANT ST, SALT LAKE CITY, UT 84116-2725
(801) 359-8862
Mailing address
659 E 800 S APT B5, SALT LAKE CITY, UT 84102-3539
(801) 759-8145
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
796
UT
Other
Enumeration date
10/19/2017
Last updated
10/19/2017
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