Provider Demographics
NPI:1497002679
Name:MUELLER, BRIAN JERALD (LPC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JERALD
Last Name:MUELLER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 MCMILLAN CT
Mailing Address - Street 2:APT. 201
Mailing Address - City:CORTLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60112-4169
Mailing Address - Country:US
Mailing Address - Phone:815-299-2560
Mailing Address - Fax:
Practice Address - Street 1:8616 NORTHERN AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5309
Practice Address - Country:US
Practice Address - Phone:815-979-3402
Practice Address - Fax:815-332-6090
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.007967101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1497002679OtherNATIONAL PROVIDER IDENTIFIER