Provider Demographics
NPI:1629269758
Name:MULLEN, MICHAEL G (LMHC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:G
Last Name:MULLEN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3066 STATE ROUTE 48
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-5733
Mailing Address - Country:US
Mailing Address - Phone:315-591-2408
Mailing Address - Fax:
Practice Address - Street 1:5 W CAYUGA ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2031
Practice Address - Country:US
Practice Address - Phone:315-342-9255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000675101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health