Provider Demographics
NPI:1174397673
Name:MUELLER, CARLEY JO
Entity type:Individual
Prefix:
First Name:CARLEY
Middle Name:JO
Last Name:MUELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARLEY
Other - Middle Name:JO
Other - Last Name:GIESEKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1427 PROVINCE TER STE B
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-7016
Mailing Address - Country:US
Mailing Address - Phone:920-738-9999
Mailing Address - Fax:
Practice Address - Street 1:1427 PROVINCE TER STE B
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-7016
Practice Address - Country:US
Practice Address - Phone:920-738-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional