Healthcare Provider Details

I. General information

NPI: 1750025367
Provider Name (Legal Business Name): DARRIS A MCMILLON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 N SAN JACINTO ST STE B
HEMET CA
92543-3109
US

IV. Provider business mailing address

31566 RAILROAD CANYON RD # 2 PMB 1003
CANYON LAKE CA
92587
US

V. Phone/Fax

Practice location:
  • Phone: 951-585-3357
  • Fax:
Mailing address:
  • Phone: 951-585-3357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: