Provider Demographics
NPI:1992825467
Name:MUELLER, ROYCE KENSTON (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROYCE
Middle Name:KENSTON
Last Name:MUELLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8335 E 130TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-3336
Mailing Address - Country:US
Mailing Address - Phone:907-345-3638
Mailing Address - Fax:
Practice Address - Street 1:1345 W 9TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3219
Practice Address - Country:US
Practice Address - Phone:907-276-7374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK0133103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist