Healthcare Provider Details

I. General information

NPI: 1629498308
Provider Name (Legal Business Name): DAWN E MILBURN LPC, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2014
Last Update Date: 09/21/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAINT ANTHONYS WAY
ALTON IL
62002-4568
US

IV. Provider business mailing address

907 LOGAN ST
ALTON IL
62002-3349
US

V. Phone/Fax

Practice location:
  • Phone: 618-465-2571
  • Fax:
Mailing address:
  • Phone: 314-378-6219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180010629
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2009036412
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: