John Thomas Mullen, PhD
Psychologist in Minneapolis, MN. Individual provider (NPI-1).
NPI number1700850823
StatusActive
Last updated in NPPESNov 10, 2020
Details
- NPI
- 1700850823
- Entity type
- Individual (NPI-1)
- Name
- John Thomas Mullen
- Credential
- PhD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Feb 15, 2006
- Certification date
- Nov 10, 2020
- Last updated
- Nov 10, 2020
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - CLINICAL PSYCHOLOGIST
- Can order and refer
- Part B Yes · DME Yes · Home health No · Power mobility No · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103T00000X | Psychologist | LP4239 | MN | Yes |
| 103TC0700X | Psychologist, Clinical | LP4239 | MN |
Practice location
913 E 26th St Ste 503Minneapolis, MN 55404-4515
Phone 612-863-5100 · Fax 612-863-5109
Mailing address
913 E 26th St Ste 503Minneapolis, MN 55404-4515
Phone 612-863-5100 · Fax 612-863-5109
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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