Provider Demographics
NPI:1770940272
Name:MUELLER, MITCHELL LEE (MPS, LPCC, LADC)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:LEE
Last Name:MUELLER
Suffix:
Gender:M
Credentials:MPS, LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1784 BARTON AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53090-5418
Mailing Address - Country:US
Mailing Address - Phone:651-497-1909
Mailing Address - Fax:
Practice Address - Street 1:1784 BARTON AVE STE 9
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53090-5418
Practice Address - Country:US
Practice Address - Phone:651-497-1909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-28
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1898101YP2500X
WI7152101YM0800X
MN304281101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)