Healthcare Provider Details

I. General information

NPI: 1194888941
Provider Name (Legal Business Name): PATRICIA LEE MILLS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PATRICIA LEE POPKIN LMFT

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3438 MENDOCINO AVE # B
SANTA ROSA CA
95403-2275
US

IV. Provider business mailing address

19950 JIGSAW RD
HIDDEN VALLEY LAKE CA
95467-8516
US

V. Phone/Fax

Practice location:
  • Phone: 707-529-3721
  • Fax: 707-900-8192
Mailing address:
  • Phone: 707-565-6900
  • Fax: 707-565-1444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number72998
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number30567
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number90335
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: