Healthcare Provider Details

I. General information

NPI: 1700979192
Provider Name (Legal Business Name): THOMAS MICHAEL MCMILLAN MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 WINCHESTER RD SOUTHEAST MENTAL HEALTH CENTER
MEMPHIS TN
38118-9007
US

IV. Provider business mailing address

3803 MARION AVE
MEMPHIS TN
38111
US

V. Phone/Fax

Practice location:
  • Phone: 901-369-1420
  • Fax: 901-369-1433
Mailing address:
  • Phone: 901-324-5448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number344
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number344
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number344
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number344
License Number StateTN
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number870
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number128
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: