Provider Demographics
NPI:1265571392
Name:MUELLER, BRENDA JEAN (MS)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:JEAN
Last Name:MUELLER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:BRENDA
Other - Middle Name:JEAN
Other - Last Name:LANGMACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2415 SUMNER ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-2943
Mailing Address - Country:US
Mailing Address - Phone:402-525-5790
Mailing Address - Fax:402-435-2274
Practice Address - Street 1:2415 SUMNER ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-2943
Practice Address - Country:US
Practice Address - Phone:402-525-5790
Practice Address - Fax:402-435-2274
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2509101YM0800X
NE1365101YM0800X
NE673101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025331-00Medicaid
NE151184OtherVALUE OPTIONS
NE239412OtherMIDLANDS CHOICE
NE84458OtherBCBS