MEDICARE: MRS. PATRICIA LEE MILLS LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	72998	CA
2	167G00000X	Licensed Psychiatric Technician	30567	CA
3	106H00000X	Marriage & Family Therapist	90335	CA

General Provider Information

NPI Number	:	1194888941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA LEE MILLS LMFT

Provider Business Mailing Address
First Line	:	19950 JIGSAW RD
Second Line	:
City	:	HIDDEN VALLEY LAKE
State	:	CA
Zip	:	95467-8516
Country	:	US
Telephone Number	:	707-565-6900
Fax Number	:	707-565-1444

Provider Business Practice Location Address
First Line	:	3438 MENDOCINO AVE # B
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-2275
Country	:	US
Telephone Number	:	707-529-3721
Fax Number	:	707-900-8192

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	11/20/2023

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