Provider Demographics
NPI:1831805480
Name:MUECKE, MARK R (LCDC; LMSW)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:R
Last Name:MUECKE
Suffix:
Gender:M
Credentials:LCDC; LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 GRAYLING LN
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-1027
Mailing Address - Country:US
Mailing Address - Phone:737-285-2041
Mailing Address - Fax:
Practice Address - Street 1:1000 HERITAGE CENTER CIR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-4463
Practice Address - Country:US
Practice Address - Phone:737-285-2041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16348101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)