Healthcare Provider Details

I. General information

NPI: 1578072203
Provider Name (Legal Business Name): MEREDITH JANE MCMILLAN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 09/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5421 US HIGHWAY 98 S
HIGHLAND CITY FL
33846
US

IV. Provider business mailing address

209 ROSE ST
AUBURNDALE FL
33823-3542
US

V. Phone/Fax

Practice location:
  • Phone: 863-701-7373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15374
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: