Provider Demographics
NPI:1356496459
Name:MULLER, PENNY ELLEN (LMFT MFC49005)
Entity Type:Individual
Prefix:MS
First Name:PENNY
Middle Name:ELLEN
Last Name:MULLER
Suffix:
Gender:F
Credentials:LMFT MFC49005
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-2155
Mailing Address - Country:US
Mailing Address - Phone:916-796-5318
Mailing Address - Fax:
Practice Address - Street 1:107 SCRIPPS DR STE 220
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6300
Practice Address - Country:US
Practice Address - Phone:916-454-9688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 49005106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist