=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043583164
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY ELIZABETH MUELLER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2012
-----------------------------------------------------
Last Update Date | 02/23/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 534 E CALL ST APT B
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32301-2550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-322-8806
-----------------------------------------------------
Fax | 229-236-0990
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 260 RALPH RICHARDS RD
-----------------------------------------------------
City | QUINCY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32351-7548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-322-8806
-----------------------------------------------------
Fax | 850-442-9029
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW3268
-----------------------------------------------------
License Number State |
-----------------------------------------------------