Individual
JOHN THOMAS MULLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
913 E 26TH ST STE 503, MINNEAPOLIS, MN 55404-4515
(612) 863-5100
(612) 863-5109
Mailing address
913 E 26TH ST STE 503, MINNEAPOLIS, MN 55404-4515
(612) 863-5100
(612) 863-5109
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP4239
MN
103TC0700X
Clinical Psychologist
LP4239
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
604909500
—
MN
Enumeration date
02/15/2006
Last updated
11/10/2020
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