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General NPI Number Information
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NPI Number | 1881878353
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Entity Type | Individual
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Provider Name | MARY THERESA MCMILLAN LMFT
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Gender | Female
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Dates
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Enumeration Date | 12/19/2007
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Last Update Date | 08/11/2021
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Provider Practice Location Address
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Address Line | 6220 GOLD DUST DR
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City | KELSEYVILLE
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State | CA
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Zip | 95451-9214
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Country | US
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Telephone | 707-972-3913
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Fax | 707-279-2679
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Provider Business Mailing Address
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Address Line | PO BOX 1236
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City | KELSEYVILLE
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State | CA
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Zip | 95451-1236
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Country | US
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Telephone | 707-972-3913
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Fax | 707-279-2679
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC38132
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License Number State | CA
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