Provider Demographics
NPI:1164563714
Name:MUELLER, SALLY J (LCPC)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:J
Last Name:MUELLER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 SADDLE DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-5646
Mailing Address - Country:US
Mailing Address - Phone:406-457-8443
Mailing Address - Fax:
Practice Address - Street 1:402 N WARREN ST
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4047
Practice Address - Country:US
Practice Address - Phone:406-324-1262
Practice Address - Fax:406-324-1231
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT555101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0255374Medicaid