Healthcare Provider Details

I. General information

NPI: 1235700881
Provider Name (Legal Business Name): THERESA MARIE MILLS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1737 MORRISON RD
FREMONT OH
43420-4857
US

IV. Provider business mailing address

140 SAINT PAUL DR
FREMONT OH
43420-9045
US

V. Phone/Fax

Practice location:
  • Phone: 419-680-5152
  • Fax:
Mailing address:
  • Phone: 419-680-5152
  • Fax: 410-835-9046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberMM6591437
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberLE-00037106
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: