Provider Demographics
NPI:1508489337
Name:MUELLER, GRACE TAYLOR
Entity Type:Individual
Prefix:MISS
First Name:GRACE
Middle Name:TAYLOR
Last Name:MUELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20360 DONOVAN DR
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:AL
Mailing Address - Zip Code:36574-2736
Mailing Address - Country:US
Mailing Address - Phone:251-348-3982
Mailing Address - Fax:
Practice Address - Street 1:21883 STATE HIGHWAY 181
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-5286
Practice Address - Country:US
Practice Address - Phone:251-463-1913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician