1164552881 NPI number — MR. JULIUS GORDON MULLEN SR. LPCMH EDD

Table of content: LUKE VAARTSTRA PH.D (NPI 1174401434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164552881 NPI number — MR. JULIUS GORDON MULLEN SR. LPCMH EDD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MULLEN
Provider First Name:
JULIUS
Provider Middle Name:
GORDON
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
LPCMH EDD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MULLEN
Provider Other First Name:
JULIUS
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1164552881
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1213 DELAWARE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-652-3948
Provider Business Mailing Address Fax Number:
302-652-8297

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1213 DELAWARE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-652-3948
Provider Business Practice Location Address Fax Number:
302-652-8297
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  PC0000397 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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