Provider Demographics
NPI:1154513323
Name:MULLER, MELISSA D (LMHC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:D
Last Name:MULLER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 MENENDEZ RD
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-5327
Mailing Address - Country:US
Mailing Address - Phone:907-617-2372
Mailing Address - Fax:904-797-5681
Practice Address - Street 1:248 SOUTHPARK CIR E
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5137
Practice Address - Country:US
Practice Address - Phone:907-617-2372
Practice Address - Fax:904-797-5681
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK516101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health