Provider Demographics
NPI:1235115932
Name:MUELLER, MARK NOLAND (LCSW)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:NOLAND
Last Name:MUELLER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:M
Other - Middle Name:NOLAND
Other - Last Name:MUELLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:VA SALT LAKE CITY HEALTH CARE SYS. MENTAL HEALTH ER
Mailing Address - Street 2:500 FOOTHILL DR.
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84148
Mailing Address - Country:US
Mailing Address - Phone:801-582-1565
Mailing Address - Fax:
Practice Address - Street 1:VA SALT LAKE CITY HEALTH CARE SYSTEM MENTAL
Practice Address - Street 2:500 FOOTHILL DR.
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84148-0001
Practice Address - Country:US
Practice Address - Phone:801-582-1565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT99-33574535011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107035233101OtherINTERMOUNTAIN HEALTH CARE
UT942938348MEUOtherEDUCATORS MUTUAL
UT003103005OtherRAILROAD MEDICARE
UT33574535001001OtherBLUE CROSS
UT9429383484121A250OtherCHAMPUS
UT633730OtherDESERET MUTUAL
UTP26861OtherMEDICARE ADVANTAGE PLUS
UT942938348MEUOtherEDUCATORS MUTUAL
UT33574535001001OtherBLUE CROSS
UTU000074546Medicare PIN
UT9429383484121A250OtherCHAMPUS