Healthcare Provider Details

I. General information

NPI: 1780169433
Provider Name (Legal Business Name): ELIZABETH ANN MUELLER LPC, SAC-IT, ATR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10012 W CAPITOL DR
MILWAUKEE WI
53222-1338
US

IV. Provider business mailing address

2771A N BREMEN ST
MILWAUKEE WI
53212-2605
US

V. Phone/Fax

Practice location:
  • Phone: 414-810-4844
  • Fax: 414-810-4845
Mailing address:
  • Phone: 414-316-8284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number18617-130
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8351-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: