Healthcare Provider Details

I. General information

NPI: 1629907654
Provider Name (Legal Business Name): CHRISTINE MCMILLEN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SMITH RANCH RD
SAN RAFAEL CA
94903-1939
US

IV. Provider business mailing address

PO BOX 6713
SAN RAFAEL CA
94903-0713
US

V. Phone/Fax

Practice location:
  • Phone: 415-491-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number94028467
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: