Provider Demographics
NPI:1154756633
Name:PAUL J. MULLEN, PSY.D., P.C.
Entity type:Organization
Organization Name:PAUL J. MULLEN, PSY.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-653-1000
Mailing Address - Street 1:1776 LEGACY CIR STE 114
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1673
Mailing Address - Country:US
Mailing Address - Phone:630-653-1000
Mailing Address - Fax:630-653-1010
Practice Address - Street 1:1776 LEGACY CIR STE 114
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1673
Practice Address - Country:US
Practice Address - Phone:630-653-1000
Practice Address - Fax:630-653-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-04
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-006034103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty