Provider Demographics
NPI:1104139310
Name:MULLER, NICOLE CATHERINE (PHD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:CATHERINE
Last Name:MULLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:CATHERINE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11956 BERNARDO PLAZA DR # 402
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2538
Mailing Address - Country:US
Mailing Address - Phone:858-859-0896
Mailing Address - Fax:
Practice Address - Street 1:2700 FIELDBROOK WAY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-1889
Practice Address - Country:US
Practice Address - Phone:858-859-0896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 390200000X
CAPSY32872103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program