Provider Demographics
NPI:1689448722
Name:MULL, GUY JR
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:
Last Name:MULL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3159 E PACKARD DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-8729
Mailing Address - Country:US
Mailing Address - Phone:480-206-2067
Mailing Address - Fax:
Practice Address - Street 1:10745 E MENDOZA AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-7820
Practice Address - Country:US
Practice Address - Phone:480-206-2067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health