Healthcare Provider Details

I. General information

NPI: 1275289878
Provider Name (Legal Business Name): RICHARD SEAN MULLEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TARA MULLEN

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 W 10TH AVE
DENVER CO
80204-3363
US

IV. Provider business mailing address

369 ELDORADO BLVD # B202
BROOMFIELD CO
80021-3693
US

V. Phone/Fax

Practice location:
  • Phone: 303-504-6500
  • Fax:
Mailing address:
  • Phone: 401-301-1785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN.1670316
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: