Healthcare Provider Details

I. General information

NPI: 1073731667
Provider Name (Legal Business Name): MICHAEL W MILLS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 766
LEBANON NH
03766-0766
US

IV. Provider business mailing address

307 CROYDON TPKE
PLAINFIELD NH
03781-5408
US

V. Phone/Fax

Practice location:
  • Phone: 603-667-8632
  • Fax:
Mailing address:
  • Phone: 603-448-6380
  • Fax: 603-448-6380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number841
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number390
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2083
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number701
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: