Healthcare Provider Details

I. General information

NPI: 1477639201
Provider Name (Legal Business Name): LISSA D. MILLS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 N CENTRAL EXPY #110
RICHARDSON TX
75080-2754
US

IV. Provider business mailing address

2201 N CENTRAL EXPY #110
RICHARDSON TX
75080-2754
US

V. Phone/Fax

Practice location:
  • Phone: 214-265-1819
  • Fax: 214-373-9530
Mailing address:
  • Phone: 214-265-1819
  • Fax: 214-373-9530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: LISSA DONELL MILLS
Title or Position: DIRECTOR
Credential:
Phone: 214-265-1819