Healthcare Provider Details

I. General information

NPI: 1013130723
Provider Name (Legal Business Name): ANTHONY SEVEROUS MULLER II MA, LLPC CAC-II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 UNION AVE SE STE A
GRAND RAPIDS MI
49507-3247
US

IV. Provider business mailing address

2139 BELMONT FARMS CIR NE
BELMONT MI
49306-8902
US

V. Phone/Fax

Practice location:
  • Phone: 616-516-9985
  • Fax:
Mailing address:
  • Phone: 616-516-9985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6401007822
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401007822
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: