Provider Demographics
NPI:1730829953
Name:MUELLER, ABIGAIL M
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:M
Last Name:MUELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 PACA ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2914
Mailing Address - Country:US
Mailing Address - Phone:510-290-8573
Mailing Address - Fax:
Practice Address - Street 1:120 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-1295
Practice Address - Country:US
Practice Address - Phone:317-512-2101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOKPM122648431045OtherBLUE CROSS BLUE SHIELD