Healthcare Provider Details

I. General information

NPI: 1770940272
Provider Name (Legal Business Name): MITCHELL LEE MUELLER MPS, LPCC, LADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2016
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1784 BARTON AVE STE 9
WEST BEND WI
53090-5418
US

IV. Provider business mailing address

1784 BARTON AVE STE 9
WEST BEND WI
53090-5418
US

V. Phone/Fax

Practice location:
  • Phone: 651-497-1909
  • Fax:
Mailing address:
  • Phone: 651-497-1909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number304281
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7152
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1898
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: