1205075397 NPI number — CHARLES MUELLER LICENSED PH. D

Table of content: CHARLES MUELLER LICENSED PH. D (NPI 1205075397)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205075397 NPI number — CHARLES MUELLER LICENSED PH. D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUELLER
Provider First Name:
CHARLES
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICENSED PH. D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205075397
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3627 KILAUEA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96816-2317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-944-7760
Provider Business Mailing Address Fax Number:
808-956-4700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2430 CAMPUS RD.
Provider Second Line Business Practice Location Address:
DEPARTMENT OF PSYCHOLOGY
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-956-6727
Provider Business Practice Location Address Fax Number:
808-956-4700
Provider Enumeration Date:
02/12/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PSY-350 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: PSY-350 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PSY-350 . This is a "STATE LICENSE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 11058-9002686 . This is a "TRUST RISK MANAGEMENT SERVICES" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".