MEDICARE: MS. KIM M MCMILLIN RN, 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	677	CO
2	101YM0800X	Mental Health Counselor	LH60434272	WA

General Provider Information

NPI Number	:	1760530471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIM M MCMILLIN RN, LMFT

Provider Business Mailing Address
First Line	:	PO BOX 8393
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99203-0393
Country	:	US
Telephone Number	:	509-979-4357
Fax Number	:	509-979-4357

Provider Business Practice Location Address
First Line	:	1402 S GRAND BLVD STE 202
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99203-5001
Country	:	US
Telephone Number	:	509-979-4357
Fax Number	:	303-926-0599

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	04/23/2015

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