=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164945069
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIREILLE MILLET
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2017
-----------------------------------------------------
Last Update Date | 01/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1950 E 5TH ST
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90802-2023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-608-2307
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 W LA VETA AVE UNIT C8
-----------------------------------------------------
City | ORANGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92868-4412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-608-2307
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MIREILLE MILLET
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 714-608-2307
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------