Provider Demographics
NPI:1023164472
Name:MULLEN-TIRAS, MARY ANN (MFT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:MULLEN-TIRAS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 N WIGET LN STE 275
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-5922
Mailing Address - Country:US
Mailing Address - Phone:925-330-7840
Mailing Address - Fax:925-944-5544
Practice Address - Street 1:190 N WIGET LN STE 275
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-5922
Practice Address - Country:US
Practice Address - Phone:925-330-7840
Practice Address - Fax:925-944-5544
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43250106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist