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General NPI Number Information
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NPI Number | 1154513323
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Entity Type | Individual
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Provider Name | MELISSA D MULLER LMHC
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Gender | Female
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 11/13/2015
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Provider Practice Location Address
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Address Line | 248 SOUTHPARK CIR E
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5137
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Country | US
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Telephone | 907-617-2372
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Fax | 904-797-5681
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Provider Business Mailing Address
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Address Line | 123 MENENDEZ RD
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City | ST AUGUSTINE
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State | FL
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Zip | 32080-5327
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Country | US
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Telephone | 907-617-2372
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Fax | 904-797-5681
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 516
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License Number State | AK
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