Provider Demographics
NPI:1780169433
Name:MUELLER, ELIZABETH ANN (LPC, SAC-IT, ATR)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:MUELLER
Suffix:
Gender:F
Credentials:LPC, SAC-IT, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2771A N BREMEN ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-2605
Mailing Address - Country:US
Mailing Address - Phone:414-316-8284
Mailing Address - Fax:
Practice Address - Street 1:10012 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-1338
Practice Address - Country:US
Practice Address - Phone:414-810-4844
Practice Address - Fax:414-810-4845
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18617-130101YA0400X
WI8351-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100091040Medicaid