Provider Demographics
NPI:1043859002
Name:MUELLER, KACEY E
Entity Type:Individual
Prefix:
First Name:KACEY
Middle Name:E
Last Name:MUELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:688 N AVENUE H APT 304
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6471
Mailing Address - Country:US
Mailing Address - Phone:208-863-6354
Mailing Address - Fax:
Practice Address - Street 1:688 N AVENUE H APT 304
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6471
Practice Address - Country:US
Practice Address - Phone:208-863-6354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-22
Last Update Date:2019-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health