Healthcare Provider Details

I. General information

NPI: 1295054302
Provider Name (Legal Business Name): LINDA LOU MILLEK B.S. CMT, C.HT.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDA LOU MILLEK BS, CMT, NBC, C.HT.

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 05/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18575 32ND ST
GOBLES MI
49055
US

IV. Provider business mailing address

18575 32ND ST
GOBLES MI
49055
US

V. Phone/Fax

Practice location:
  • Phone: 269-628-0202
  • Fax: 269-628-0202
Mailing address:
  • Phone: 269-628-0202
  • Fax: 269-628-0202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: