Healthcare Provider Details

I. General information

NPI: 1902256662
Provider Name (Legal Business Name): DEIDEDRE LYNN MILLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 06/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 ALTON WAY APT 2113
DENVER CO
80230-6144
US

IV. Provider business mailing address

550 ALTON WAY APT 2113
DENVER CO
80230-6144
US

V. Phone/Fax

Practice location:
  • Phone: 720-327-5189
  • Fax:
Mailing address:
  • Phone: 720-327-5189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number390200000
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number39
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: