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General NPI Number Information
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NPI Number | 1750977864
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Entity Type | Individual
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Provider Name | MICHAEL S MILLIGAN LCSW
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Gender | Male
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Dates
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Enumeration Date | 12/14/2020
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Last Update Date | 12/17/2020
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Provider Practice Location Address
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Address Line | 601 POLE LINE RD
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City | TWIN FALLS
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State | ID
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Zip | 83301-4085
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Country | US
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Telephone | 208-814-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 1176 STARFIRE ST
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City | TWIN FALLS
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State | ID
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Zip | 83301-3146
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Country | US
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Telephone | 208-421-7024
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-39077
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License Number State | ID
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