Healthcare Provider Details

I. General information

NPI: 1114888112
Provider Name (Legal Business Name): ANN LK MILLIKIN, LCPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 VADALABENE DR STE A
MARYVILLE IL
62062-6901
US

IV. Provider business mailing address

515 ACORN WAY
LEBANON IL
62254-1158
US

V. Phone/Fax

Practice location:
  • Phone: 618-604-1696
  • Fax: 618-288-0737
Mailing address:
  • Phone: 618-604-1696
  • Fax: 618-288-0737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANN LK MILLIKIN
Title or Position: MENTAL HEALTH THERAPIST
Credential: LCPC
Phone: 618-604-1696