Organization
MARY MULLENBACH, PHD, LP, INC
Active
Other names
Legacy Mental Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY MULLENBACH PH.D., L.P. (PRESIDENT)
(612) 801-3316
Entity
Organization
Contact information
Practice address
6550 YORK AVE. S., SUITE 503, EDINA, MN 55435
(612) 801-3316
Mailing address
6550 YORK AVE. S., SUITE 503, EDINA, MN 55435-2336
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
4360
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801192937
—
MN
Enumeration date
06/28/2011
Last updated
08/23/2018
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