Provider Demographics
NPI:1861026544
Name:MULLEN, MICHAEL (LCSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:MULLEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5305 APOLLO DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-5711
Mailing Address - Country:US
Mailing Address - Phone:505-553-0704
Mailing Address - Fax:
Practice Address - Street 1:5305 APOLLO DR NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-5711
Practice Address - Country:US
Practice Address - Phone:505-553-0704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLSW168981041C0700X
NMC-109531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical