Healthcare Provider Details

I. General information

NPI: 1528837960
Provider Name (Legal Business Name): MILLS PRO COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2023
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94210 HOLDENBURY DR UNIT B
FORT DRUM NY
13603-3268
US

IV. Provider business mailing address

94210 HOLDENBURY DR UNIT B
FORT DRUM NY
13603-3268
US

V. Phone/Fax

Practice location:
  • Phone: 580-373-2820
  • Fax: 580-547-5242
Mailing address:
  • Phone: 580-373-2820
  • Fax: 580-547-5242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELLY BETH MILLS
Title or Position: SOLE PRACTITIONER/OWNER
Credential: LPC, NCC, CCMHC
Phone: 580-373-2820