MEDICARE: MILLIA PROMOTIONAL SERVICES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	104100000X	Social Worker
3	106S00000X	Behavior Technician
4	171M00000X	Case Manager/Care Coordinator
5	175T00000X	Peer Specialist
6	225C00000X	Rehabilitation Counselor
7	225CX0006X	Orientation and Mobility Training Rehabilitation Counselor
8	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility
9	320700000X	Physical Disabilities Residential Treatment Facility
10	320800000X	Mental Illness Community Based Residential Treatment Facility
11	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility
12	385HR2050X	Respite Care Camp
13	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
14	103TP2701X	Group Psychotherapy Psychologist

General Provider Information

NPI Number	:	1578029682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLIA PROMOTIONAL SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 46324
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85063-6324
Country	:	US
Telephone Number	:	480-233-9783
Fax Number	:	480-718-7710

Provider Business Practice Location Address
First Line	:	9617 N METRO PKWY W
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-1400
Country	:	US
Telephone Number	:	480-233-9783
Fax Number	:	480-718-7710

Authorized Official
Title or Position	:	CEO
Name	:	MS. KHAMILLIA A HARRIS
Credential	:
Telephone Number	:	480-233-9783

Provider Enumeration Date	:	02/13/2019
Last Update Date	:	02/13/2019

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