Healthcare Provider Details

I. General information

NPI: 1083483382
Provider Name (Legal Business Name): JUSTIN CAREY MILLARD MS, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 E OSBORN RD # 101
PHOENIX AZ
85016-7236
US

IV. Provider business mailing address

1040 E OSBORN RD UNIT 203
PHOENIX AZ
85014-5249
US

V. Phone/Fax

Practice location:
  • Phone: 602-237-5549
  • Fax:
Mailing address:
  • Phone: 480-307-0627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-23147
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: