Provider Demographics
NPI:1518791003
Name:MULNICK, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:MULNICK
Suffix:
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:PO BOX 330
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-0330
Mailing Address - Country:US
Mailing Address - Phone:208-315-3663
Mailing Address - Fax:
Practice Address - Street 1:4001 OFFICE COURT DRIVER STE 102
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4903
Practice Address - Country:US
Practice Address - Phone:505-395-9437
Practice Address - Fax:505-930-5427
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health