Provider Demographics
NPI:1295176816
Name:MULKEY, MARTY (LMFT)
Entity type:Individual
Prefix:MR
First Name:MARTY
Middle Name:
Last Name:MULKEY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 GOUGH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-4464
Mailing Address - Country:US
Mailing Address - Phone:415-820-1540
Mailing Address - Fax:415-476-7747
Practice Address - Street 1:414 GOUGH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-4464
Practice Address - Country:US
Practice Address - Phone:415-820-1540
Practice Address - Fax:415-476-7747
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 47057106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist