Provider Demographics
NPI:1760200455
Name:MULLEN, TRISTIAN (CSW)
Entity type:Individual
Prefix:
First Name:TRISTIAN
Middle Name:
Last Name:MULLEN
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 W 4250 S
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-3321
Mailing Address - Country:US
Mailing Address - Phone:208-431-8013
Mailing Address - Fax:
Practice Address - Street 1:907 W CLARK LN
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2695
Practice Address - Country:US
Practice Address - Phone:208-431-8013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT134599683502101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health