Healthcare Provider Details

I. General information

NPI: 1639370836
Provider Name (Legal Business Name): ASHLEY JOHNSON MILLS M.ED., LPC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 S VETERANS BLVD
TUPELO MS
38804-5022
US

IV. Provider business mailing address

465 COUNTY ROAD 513
RIENZI MS
38865-9507
US

V. Phone/Fax

Practice location:
  • Phone: 662-840-3008
  • Fax: 662-841-0337
Mailing address:
  • Phone: 662-840-3008
  • Fax: 662-841-0337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1151
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: