Provider Demographics
NPI:1982837324
Name:MULL, JENNY ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:ELIZABETH
Last Name:MULL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 COORS BLVD NW STE C
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1721
Mailing Address - Country:US
Mailing Address - Phone:505-652-4002
Mailing Address - Fax:505-272-1538
Practice Address - Street 1:3320 COORS BLVD NW STE C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1721
Practice Address - Country:US
Practice Address - Phone:505-652-4002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-087911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM78854849Medicaid