Provider Demographics
NPI:1821024894
Name:MUELLER, MARY (PAT) PATRICIA (MS, LPC-MH, CCDC III)
Entity Type:Individual
Prefix:MRS
First Name:MARY (PAT)
Middle Name:PATRICIA
Last Name:MUELLER
Suffix:
Gender:F
Credentials:MS, LPC-MH, CCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:CHAMBERLAIN
Mailing Address - State:SD
Mailing Address - Zip Code:57325-0186
Mailing Address - Country:US
Mailing Address - Phone:605-734-6210
Mailing Address - Fax:605-734-4047
Practice Address - Street 1:209 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CHAMBERLAIN
Practice Address - State:SD
Practice Address - Zip Code:57325-1240
Practice Address - Country:US
Practice Address - Phone:605-734-6210
Practice Address - Fax:605-734-4047
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH2141101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health