Healthcare Provider Details

I. General information

NPI: 1235184250
Provider Name (Legal Business Name): BRIAN MUTCHLER PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BROAD ROCK BLVD VAMC / MENTAL HEALTH SERVICE LINE
RICHMOND VA
23249-0001
US

IV. Provider business mailing address

1201 BROAD ROCK BLVD VAMC / MENTAL HEALTH SERVICE LINE
RICHMOND VA
23249-0001
US

V. Phone/Fax

Practice location:
  • Phone: 804-675-5000
  • Fax: 804-675-6853
Mailing address:
  • Phone: 804-675-5000
  • Fax: 804-675-6853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810002766
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: