Provider Demographics
NPI:1285213637
Name:OSTLER, MYCHAL STEPHEN
Entity Type:Individual
Prefix:
First Name:MYCHAL
Middle Name:STEPHEN
Last Name:OSTLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 POINT ROYAL DR
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-6491
Mailing Address - Country:US
Mailing Address - Phone:360-921-9603
Mailing Address - Fax:
Practice Address - Street 1:320 N JUDD PKWY NE STE 200
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-2624
Practice Address - Country:US
Practice Address - Phone:919-557-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health