Healthcare Provider Details

I. General information

NPI: 1821757725
Provider Name (Legal Business Name): ANDREW MULLEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8205 SPAIN RD NE STE 106
ALBUQUERQUE NM
87109-3155
US

IV. Provider business mailing address

2501 YALE BLVD SE STE 101
ALBUQUERQUE NM
87106-4356
US

V. Phone/Fax

Practice location:
  • Phone: 505-856-0300
  • Fax:
Mailing address:
  • Phone: 505-382-5644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2026-0561
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2026-0165
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: