Provider Demographics
NPI:1154514289
Name:MUELLER, FELICIA ANN (PSYD)
Entity type:Individual
Prefix:DR
First Name:FELICIA
Middle Name:ANN
Last Name:MUELLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 J ST
Mailing Address - Street 2:
Mailing Address - City:FORKS
Mailing Address - State:WA
Mailing Address - Zip Code:98331-9165
Mailing Address - Country:US
Mailing Address - Phone:360-374-6060
Mailing Address - Fax:
Practice Address - Street 1:51 N SPARTAN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:FORKS
Practice Address - State:WA
Practice Address - Zip Code:98331-9051
Practice Address - Country:US
Practice Address - Phone:360-374-6060
Practice Address - Fax:360-374-6691
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003795103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA11819500OtherREGENCE
WA11819500OtherAETNA
WA8871134OtherMEDICARE PTAN