1114187267 NPI number — EDWARD DAVID MULLIGAN III LCSW

Table of content: EDWARD DAVID MULLIGAN III LCSW (NPI 1114187267)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114187267 NPI number — EDWARD DAVID MULLIGAN III LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MULLIGAN
Provider First Name:
EDWARD
Provider Middle Name:
DAVID
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114187267
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1901 HIGHWAY 190 APT 1323
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANDEVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70448-3486
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-774-0175
Provider Business Mailing Address Fax Number:
985-377-0980

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2315 FLORIDA STREET BLDG 200,
Provider Second Line Business Practice Location Address:
SUITE 226
Provider Business Practice Location Address City Name:
MANDEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-774-0175
Provider Business Practice Location Address Fax Number:
985-377-0980
Provider Enumeration Date:
06/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  6610 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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