Healthcare Provider Details

I. General information

NPI: 1396866604
Provider Name (Legal Business Name): PATRICIA A MCMILLAN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. TRISH MCMILLAN

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 S MCCLINTOCK DR SUITE 105
TEMPE AZ
85282-2692
US

IV. Provider business mailing address

967 S COLONIAL DR
GILBERT AZ
85296-8389
US

V. Phone/Fax

Practice location:
  • Phone: 480-804-0326
  • Fax: 480-302-7884
Mailing address:
  • Phone: 480-827-1748
  • Fax: 480-827-1748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-2684
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: