Provider Demographics
NPI:1710509047
Name:MALLEN, JUSTIN (BS)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:MALLEN
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 LIPAN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4312
Mailing Address - Country:US
Mailing Address - Phone:201-694-9181
Mailing Address - Fax:
Practice Address - Street 1:5575 S SYCAMORE ST STE 108
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-1141
Practice Address - Country:US
Practice Address - Phone:201-694-9181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor