Provider Demographics
NPI:1043497035
Name:MULLEN, JOSEPH MICHEAL III (MS,LMFT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MICHEAL
Last Name:MULLEN
Suffix:III
Gender:M
Credentials:MS,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6988 FOX RD
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-9758
Mailing Address - Country:US
Mailing Address - Phone:218-251-6700
Mailing Address - Fax:218-454-8025
Practice Address - Street 1:6988 FOX RD
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-9758
Practice Address - Country:US
Practice Address - Phone:218-251-6700
Practice Address - Fax:218-454-8025
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1627106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist