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General NPI Number Information
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NPI Number | 1215219019
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Entity Type | Individual
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Provider Name | JONNIE M MUCKELROY
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Gender | Female
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Dates
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Enumeration Date | 09/16/2011
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Last Update Date | 04/26/2025
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Provider Practice Location Address
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Address Line | 190 SIERRA CT STE C4
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City | PALMDALE
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State | CA
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Zip | 93550-7609
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Country | US
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Telephone | 661-941-1131
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Fax |
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Provider Business Mailing Address
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Address Line | 37951 47TH ST E # A7-221
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City | PALMDALE
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State | CA
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Zip | 93552-3264
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Country | US
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Telephone | 661-941-1131
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT116647
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | IMF84193
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License Number State | CA
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