Healthcare Provider Details

I. General information

NPI: 1255605846
Provider Name (Legal Business Name): KRISTI L MUELLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S EAGLE RD
MERIDIAN ID
83642-6351
US

IV. Provider business mailing address

10400 W OVERLAND RD # 293
BOISE ID
83709-1433
US

V. Phone/Fax

Practice location:
  • Phone: 208-706-4182
  • Fax:
Mailing address:
  • Phone: 208-314-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8911440
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: