Healthcare Provider Details

I. General information

NPI: 1740983410
Provider Name (Legal Business Name): MARIYA MILAN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

673 S AUBURN ST
GRASS VALLEY CA
95945-7576
US

IV. Provider business mailing address

673 S AUBURN ST STE B
GRASS VALLEY CA
95945-7576
US

V. Phone/Fax

Practice location:
  • Phone: 530-913-7221
  • Fax:
Mailing address:
  • Phone: 714-913-7849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number123031
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: