Healthcare Provider Details

I. General information

NPI: 1851853063
Provider Name (Legal Business Name): ERIC MARTIN MILLS LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 04/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 SOUTH 17TH STREET
AMES IA
50010
US

IV. Provider business mailing address

6200 AURORA AVE STE 401E
URBANDALE IA
50322-2866
US

V. Phone/Fax

Practice location:
  • Phone: 515-290-6881
  • Fax:
Mailing address:
  • Phone: 515-331-0303
  • Fax: 515-331-9086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number007283
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: