Provider Demographics
NPI:1295724904
Name:MULDER, DENNIS L (EDD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:L
Last Name:MULDER
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 PARK ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-3736
Mailing Address - Country:US
Mailing Address - Phone:231-739-3320
Mailing Address - Fax:231-737-9116
Practice Address - Street 1:3535 PARK ST
Practice Address - Street 2:SUITE 112
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-3736
Practice Address - Country:US
Practice Address - Phone:231-739-3320
Practice Address - Fax:231-737-9116
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006356103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist