Provider Demographics
NPI:1255659579
Name:MUELLER, JARED (LISW)
Entity Type:Individual
Prefix:MR
First Name:JARED
Middle Name:
Last Name:MUELLER
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:JARED
Other - Middle Name:K
Other - Last Name:MUELLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW
Mailing Address - Street 1:1 PRESTIGE PL STE 550
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-6115
Mailing Address - Country:US
Mailing Address - Phone:937-762-1310
Mailing Address - Fax:937-522-8493
Practice Address - Street 1:6661 CLYO RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-2767
Practice Address - Country:US
Practice Address - Phone:937-425-4000
Practice Address - Fax:937-425-4002
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
OHI.17001061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker