Provider Demographics
NPI:1205075397
Name:MUELLER, CHARLES (LICENSED PH D)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:MUELLER
Suffix:
Gender:M
Credentials:LICENSED PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3627 KILAUEA AVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-2317
Mailing Address - Country:US
Mailing Address - Phone:808-944-7760
Mailing Address - Fax:808-956-4700
Practice Address - Street 1:2430 CAMPUS RD.
Practice Address - Street 2:DEPARTMENT OF PSYCHOLOGY
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822
Practice Address - Country:US
Practice Address - Phone:808-956-6727
Practice Address - Fax:808-956-4700
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILPSY-350103T00000X
HIPSY-350103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIPSY-350OtherSTATE LICENSE
IL11058-9002686OtherTRUST RISK MANAGEMENT SERVICES