Healthcare Provider Details

I. General information

NPI: 1104139310
Provider Name (Legal Business Name): NICOLE CATHERINE MULLER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS NICOLE CATHERINE JOHNSON

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 FIELDBROOK WAY
ESCONDIDO CA
92027-1889
US

IV. Provider business mailing address

11956 BERNARDO PLAZA DR # 402
SAN DIEGO CA
92128-2538
US

V. Phone/Fax

Practice location:
  • Phone: 858-859-0896
  • Fax:
Mailing address:
  • Phone: 858-859-0896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY32872
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: