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General NPI Number Information
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NPI Number | 1801311329
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Entity Type | Organization
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Legal Business Name | SUSAN MILLNER THERAPEUTIC SERVICES LLC
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Dates
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Enumeration Date | 08/04/2017
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Last Update Date | 08/04/2017
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Provider Practice Location Address
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Address Line | 9711 SKOKIE BLVD
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City | SKOKIE
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State | IL
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Zip | 60077-1384
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Country | US
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Telephone | 847-525-4131
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Fax |
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Provider Business Mailing Address
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Address Line | 922 ROLLINGWOOD RD
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-3958
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Country | US
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Telephone | 18475254131
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUSAN MILLNER
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Credential | LCSW
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Telephone | 847-525-4131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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