1396866604 NPI number — MS. PATRICIA A MCMILLAN MSW, LCSW

Table of content: MS. PATRICIA A MCMILLAN MSW, LCSW (NPI 1396866604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396866604 NPI number — MS. PATRICIA A MCMILLAN MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCMILLAN
Provider First Name:
PATRICIA
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCMILLAN
Provider Other First Name:
TRISH
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1396866604
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
967 S COLONIAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GILBERT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85296-8389
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-827-1748
Provider Business Mailing Address Fax Number:
480-827-1748

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2120 S MCCLINTOCK DR
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85282-2692
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-804-0326
Provider Business Practice Location Address Fax Number:
480-302-7884
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCSW-2684 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 917271 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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