Healthcare Provider Details

I. General information

NPI: 1225261340
Provider Name (Legal Business Name): NATHANIEL PRENTICE MILLS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 I ST STE 103
SACRAMENTO CA
95816-4311
US

IV. Provider business mailing address

2830 I ST STE 103
SACRAMENTO CA
95816-4311
US

V. Phone/Fax

Practice location:
  • Phone: 916-722-7792
  • Fax:
Mailing address:
  • Phone: 916-722-7792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: