MEDICARE: NICOLE MUELLER LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	0717002104	VA

General Provider Information

NPI Number	:	1013765734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MUELLER LMFT

Provider Business Mailing Address
First Line	:	209 W CRISER RD STE 300
Second Line	:
City	:	FRONT ROYAL
State	:	VA
Zip	:	22630-2360
Country	:	US
Telephone Number	:	540-636-4250
Fax Number	:	540-636-7171

Provider Business Practice Location Address
First Line	:	136 GENERAL DR STE 300
Second Line	:
City	:	LURAY
State	:	VA
Zip	:	22835-5263
Country	:	US
Telephone Number	:	540-743-4548
Fax Number	:	540-743-6067

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2024
Last Update Date	:	05/08/2024

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