1235115932 NPI number — MARK NOLAND MUELLER LCSW

Table of content: MARK NOLAND MUELLER LCSW (NPI 1235115932)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235115932 NPI number — MARK NOLAND MUELLER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUELLER
Provider First Name:
MARK
Provider Middle Name:
NOLAND
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MUELLER
Provider Other First Name:
M
Provider Other Middle Name:
NOLAND
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1235115932
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
VA SALT LAKE CITY HEALTH CARE SYS. MENTAL HEALTH ER
Provider Second Line Business Mailing Address:
500 FOOTHILL DR.
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-582-1565
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
VA SALT LAKE CITY HEALTH CARE SYSTEM MENTAL
Provider Second Line Business Practice Location Address:
500 FOOTHILL DR.
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84148-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-582-1565
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2005

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: 1041C0700X , with the licence number:  99-3357453501 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 107035233101 . This is a "INTERMOUNTAIN HEALTH CARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 942938348MEU . This is a "EDUCATORS MUTUAL" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 003103005 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 33574535001001 . This is a "BLUE CROSS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 9429383484121A250 . This is a "CHAMPUS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 633730 . This is a "DESERET MUTUAL" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: P26861 . This is a "MEDICARE ADVANTAGE PLUS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com