Provider Demographics
NPI:1467014803
Name:MULLEN, TYIS BRITTANY (BA)
Entity Type:Individual
Prefix:
First Name:TYIS
Middle Name:BRITTANY
Last Name:MULLEN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-8213
Mailing Address - Country:US
Mailing Address - Phone:410-567-6139
Mailing Address - Fax:
Practice Address - Street 1:214 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-8213
Practice Address - Country:US
Practice Address - Phone:410-567-6139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-06
Last Update Date:2019-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst