Healthcare Provider Details

I. General information

NPI: 1053223941
Provider Name (Legal Business Name): MR. GAGE SPENCER MULLINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 S COLORADO BLVD #NORTH
DENVER CO
80246-1904
US

IV. Provider business mailing address

99 S BROADWAY APT 130
DENVER CO
80209-1789
US

V. Phone/Fax

Practice location:
  • Phone: 720-440-8036
  • Fax:
Mailing address:
  • Phone: 708-476-0221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-420774
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: