Provider Demographics
NPI:1831756238
Name:MUELLER, MARC KEDAR (LMHC)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:KEDAR
Last Name:MUELLER
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 301
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-0060
Mailing Address - Country:US
Mailing Address - Phone:253-350-4386
Mailing Address - Fax:
Practice Address - Street 1:314 27TH ST NE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3105
Practice Address - Country:US
Practice Address - Phone:253-350-4386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-22
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61262920101YM0800X
WAMC60945630101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty