Provider Demographics
NPI:1710215991
Name:MUELLER, STEPHANIE (BS, CAC III, LADAC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MUELLER
Suffix:
Gender:F
Credentials:BS, CAC III, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W 11TH ST STE 112
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5108
Mailing Address - Country:US
Mailing Address - Phone:970-739-8970
Mailing Address - Fax:970-259-2690
Practice Address - Street 1:1053 MAIN AVE STE 112
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5594
Practice Address - Country:US
Practice Address - Phone:970-739-8970
Practice Address - Fax:970-259-2690
Is Sole Proprietor?:No
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3521101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)