Provider Demographics
NPI:1023255478
Name:MUELLER, CRYSTAL (PHD)
Entity type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:
Last Name:MUELLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1079
Mailing Address - Street 2:
Mailing Address - City:RUNNING SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92382-1079
Mailing Address - Country:US
Mailing Address - Phone:909-425-7628
Mailing Address - Fax:
Practice Address - Street 1:3102 E. HIGHLAND AVE.
Practice Address - Street 2:PATTON STATE HOSPITAL
Practice Address - City:PATTON
Practice Address - State:CA
Practice Address - Zip Code:92369
Practice Address - Country:US
Practice Address - Phone:909-425-7628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21896103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA21896OtherCALIFORNIA PSYCHOLOGY LICENSE #