Healthcare Provider Details

I. General information

NPI: 1598408494
Provider Name (Legal Business Name): PEGGY MILLS LH61615427, 61632795
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N 2ND ST
YAKIMA WA
98901-2334
US

IV. Provider business mailing address

315 N 2ND ST
YAKIMA WA
98901-2334
US

V. Phone/Fax

Practice location:
  • Phone: 509-469-9366
  • Fax:
Mailing address:
  • Phone: 509-469-9366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP.CP.61632795
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC.LH.61615427
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: