=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043904006
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A MILLS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2023
-----------------------------------------------------
Last Update Date | 06/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 557 HILDEBRAND ST
-----------------------------------------------------
City | SOUTH BEND
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46614-5567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-261-2416
-----------------------------------------------------
Fax | 574-807-9616
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 557 HILDEBRAND ST
-----------------------------------------------------
City | SOUTH BEND
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46614-5567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-261-2416
-----------------------------------------------------
Fax | 574-807-9616
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ANGELA MILLS-KOHLER
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 574-261-2416
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------