Provider Demographics
NPI:1396194908
Name:MULDER, EMILE (PHD)
Entity Type:Individual
Prefix:
First Name:EMILE
Middle Name:
Last Name:MULDER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16930 ROBBINS RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2787
Mailing Address - Country:US
Mailing Address - Phone:616-935-7606
Mailing Address - Fax:616-935-7607
Practice Address - Street 1:16930 ROBBINS RD
Practice Address - Street 2:SUITE 120
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2787
Practice Address - Country:US
Practice Address - Phone:616-935-7606
Practice Address - Fax:616-935-7607
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016347103TB0200X, 103TC0700X, 103TC2200X, 103TM1800X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy