Healthcare Provider Details

I. General information

NPI: 1366774911
Provider Name (Legal Business Name): TAMMIE SUE MUELLER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 LAND OF GOSHEN DR
SPRINGTOWN TX
76082-5711
US

IV. Provider business mailing address

PO BOX 1502
SPRINGTOWN TX
76082-1502
US

V. Phone/Fax

Practice location:
  • Phone: 817-233-5049
  • Fax:
Mailing address:
  • Phone: 817-233-5049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number63488
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: