Individual provider Active NPI

Matthias McBroom Mullin

  • Behavior Technician
  • Burnsville, MN
National Provider Identifier
1831769116
Registry record updated Mar 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior TechnicianTaxonomy code 106S00000X
Practice address
1517 Highway 13 E
Burnsville, MN 55337-2917
Phone
(612) 756-9107
NPI assigned
Jun 29, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X Primary

Addresses

Primary practice location

1517 Highway 13 E
Burnsville, MN 55337-2917

Mailing address

1517 Highway 13 E
Burnsville, MN 55337-2917
Phone (612) 756-9107

Other practice location 1

9201 Old Cedar Ave S
Bloomington, MN 55425-2401
Phone (952) 854-1800

Other practice location 2

19437 Evans St NW
Elk River, MN 55330-1074
Phone (763) 515-3532

Other practice location 3

109 Doctors Park
Saint Cloud, MN 56303-1207
Phone (320) 774-1908

Other practice location 4

59 Glenn Rd NW
Alexandria, MN 56308-4007
Phone (320) 219-7644

Other practice location 5

205 14th Ave E
Sartell, MN 56377-4500
Phone (320) 774-3436

Other practice location 6

108 Doctors Park
Saint Cloud, MN 56303-1207
Phone (320) 774-3915

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Northway Academy, Inc. CurrentSince Jul 4, 2021 Accepting new patients
Jtcounselingservices Past Accepting new patients
Northway Academy, Inc. PastSince Jun 22, 2021 Accepting new patients
Northway Academy, Inc. PastSince Jul 4, 2021 Accepting new patients
Northway Academy, Inc. Past Accepting new patients

Locations

19437 Evans St NW
Elk River, MN 55330
Phone (763) 515-3532

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1624924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774310400000",
    "number": "1831769116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1517 HIGHWAY 13 E",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553372917",
            "telephone_number": "612-756-9107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1517 HIGHWAY 13 E",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553372917",
            "telephone_number": "612-756-9107"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9201 Old Cedar Ave S",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "MN",
            "postal_code": "554252401",
            "country_code": "US",
            "telephone_number": "952-854-1800",
            "fax_number": "952-854-5502",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "19437 Evans St NW",
            "address_purpose": "LOCATION",
            "city": "Elk River",
            "state": "MN",
            "postal_code": "553301074",
            "country_code": "US",
            "telephone_number": "763-515-3532",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "109 Doctors Park",
            "address_purpose": "LOCATION",
            "city": "Saint Cloud",
            "state": "MN",
            "postal_code": "563031207",
            "country_code": "US",
            "telephone_number": "320-774-1908",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "59 Glenn Rd NW",
            "address_purpose": "LOCATION",
            "city": "Alexandria",
            "state": "MN",
            "postal_code": "563084007",
            "country_code": "US",
            "telephone_number": "320-219-7644",
            "fax_number": "320-219-7818",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "205 14th Ave E",
            "address_purpose": "LOCATION",
            "city": "Sartell",
            "state": "MN",
            "postal_code": "563774500",
            "country_code": "US",
            "telephone_number": "320-774-3436",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "108 Doctors Park",
            "address_purpose": "LOCATION",
            "city": "Saint Cloud",
            "state": "MN",
            "postal_code": "563031207",
            "country_code": "US",
            "telephone_number": "320-774-3915",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MULLIN",
        "first_name": "MATTHIAS",
        "middle_name": "MCBROOM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-29",
        "last_updated": "2026-03-24",
        "certification_date": "2026-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burnsville, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.