Provider Demographics
NPI:1245241785
Name:MUELLER, DEBRA G (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:G
Last Name:MUELLER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2344 E JULIET ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1930
Mailing Address - Country:US
Mailing Address - Phone:208-854-7029
Mailing Address - Fax:
Practice Address - Street 1:500 W. FORT STREET
Practice Address - Street 2:VA MEDICAL CENTER (531/122)
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702
Practice Address - Country:US
Practice Address - Phone:208-422-1000
Practice Address - Fax:208-422-1323
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-285441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDLCSW-28544OtherDIVISION OF OCCUPATIONAL LICENSES