MEDICARE: JOHN MULLIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	13655	NE

General Provider Information

NPI Number	:	1760106959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN MULLIN

Provider Business Mailing Address
First Line	:	4702 N 133RD PLZ APT 111
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68164-1010
Country	:	US
Telephone Number	:	402-630-2016
Fax Number	:

Provider Business Practice Location Address
First Line	:	17712 JOSEPHINE ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68136-2023
Country	:	US
Telephone Number	:	402-366-3472
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2022
Last Update Date	:	11/14/2023

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Directions to “ JOHN MULLIN ” Practice Location

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