Provider Demographics
NPI:1740377043
Name:MUELLER, KAREN L (LICSW)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:MUELLER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E BROADWAY
Mailing Address - Street 2:SUITE 611
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504
Mailing Address - Country:US
Mailing Address - Phone:701-223-7540
Mailing Address - Fax:701-223-7540
Practice Address - Street 1:400 E BROADWAY
Practice Address - Street 2:SUITE 611
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501
Practice Address - Country:US
Practice Address - Phone:701-223-7540
Practice Address - Fax:701-223-7540
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1093104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
11789Medicare ID - Type Unspecified