Healthcare Provider Details

I. General information

NPI: 1134693666
Provider Name (Legal Business Name): JORDYN MUELLER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 HUFFSTETLER DR STE 11
EUSTIS FL
32726-8225
US

IV. Provider business mailing address

PO BOX 491000
LEESBURG FL
34749-1000
US

V. Phone/Fax

Practice location:
  • Phone: 352-483-1652
  • Fax: 352-360-6656
Mailing address:
  • Phone: 352-315-7531
  • Fax: 352-315-7587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH16639
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: