MEDICARE: MARTHA MULLER 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	MT2790	FL

General Provider Information

NPI Number	:	1043619190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA MULLER LMFT

Provider Business Mailing Address
First Line	:	122 S SEGRAVE ST
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-4260
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 S SEGRAVE ST
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-4260
Country	:	US
Telephone Number	:	386-248-0712
Fax Number	:

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

Provider Enumeration Date	:	08/14/2014
Last Update Date	:	08/14/2014

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