Individual
SHANE D MULLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2112 W FAIDLEY AVE, GRAND ISLAND, NE 68803-4670
(308) 398-5427
(308) 398-5404
Mailing address
1342 N BALTIMORE AVE, HASTINGS, NE 68901-2919
(402) 831-0009
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
P-2248
NE
Other
Enumeration date
01/28/2025
Last updated
01/28/2025
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