Provider Demographics
NPI:1154391449
Name:MUFFLEY, CHAD E (MA LLP)
Entity type:Individual
Prefix:MR
First Name:CHAD
Middle Name:E
Last Name:MUFFLEY
Suffix:
Gender:M
Credentials:MA LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5220 LOVERS LANE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002
Mailing Address - Country:US
Mailing Address - Phone:269-344-3080
Mailing Address - Fax:269-344-0543
Practice Address - Street 1:5220 LOVERS LANE
Practice Address - Street 2:SUITE 120
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002
Practice Address - Country:US
Practice Address - Phone:269-344-3080
Practice Address - Fax:269-344-0543
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011598103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent