Provider Demographics
NPI:1578518965
Name:MULLER, RAQUEL DOLORES (PHD)
Entity Type:Individual
Prefix:DR
First Name:RAQUEL
Middle Name:DOLORES
Last Name:MULLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7145 SW VARNS ST STE 103
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8170
Mailing Address - Country:US
Mailing Address - Phone:503-847-9215
Mailing Address - Fax:
Practice Address - Street 1:7145 SW VARNS ST STE 103
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8170
Practice Address - Country:US
Practice Address - Phone:503-847-9215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23329103T00000X
MO2005005751103TC0700X
OR2714103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO499103307Medicaid
MO219994052Medicare ID - Type Unspecified