Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | C2158 | OR |
Y | 101YM0800X | Mental Health Counselor | RC00046805 | WA |
NPI | 1003046475 |
---|---|
Provider Name | Antonia M Mueller |
First Address | Vancouver, WA 98668-1845 |
Second Address | Vancouver, WA 98661-3753 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2009 |
Last Update Date | 20/07/2009 |