Healthcare Provider Details

I. General information

NPI: 1689843229
Provider Name (Legal Business Name): AMY ELIZABETH MUELLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11716 ENTERPRISE DR
AUBURN CA
95603-3732
US

IV. Provider business mailing address

11716 ENTERPRISE DR
AUBURN CA
95603-3732
US

V. Phone/Fax

Practice location:
  • Phone: 530-889-6700
  • Fax: 530-889-6735
Mailing address:
  • Phone: 530-889-6700
  • Fax: 530-889-6735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11763
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: