Healthcare Provider Details

I. General information

NPI: 1407507486
Provider Name (Legal Business Name): MARSHA D MILLESON PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4905 S NATIONAL AVE
SPRINGFIELD MO
65810-2989
US

IV. Provider business mailing address

4905 S NATIONAL AVE
SPRINGFIELD MO
65810-2989
US

V. Phone/Fax

Practice location:
  • Phone: 417-763-9001
  • Fax:
Mailing address:
  • Phone: 417-763-9001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2019031206
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: