Healthcare Provider Details

I. General information

NPI: 1073932380
Provider Name (Legal Business Name): JULIE MCMILLIN LCPC, LAC, MAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 1ST AVE
LAUREL MT
59044-3031
US

IV. Provider business mailing address

PO BOX 33
BRIDGER MT
59014-0033
US

V. Phone/Fax

Practice location:
  • Phone: 406-446-0337
  • Fax: 406-646-3020
Mailing address:
  • Phone: 406-446-0337
  • Fax: 406-646-3020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3633
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7777
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: