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General NPI Number Information
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NPI Number | 1972040525
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Entity Type | Individual
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Provider Name | JASON ROBERTS MILLIKAN LPCA
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Gender | Male
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Dates
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Enumeration Date | 01/20/2017
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Last Update Date | 01/20/2017
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Provider Practice Location Address
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Address Line | 230 2ND ST STE 308
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City | HENDERSON
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State | KY
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Zip | 42420-3176
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Country | US
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Telephone | 270-827-8671
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Fax |
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Provider Business Mailing Address
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Address Line | 232 W OBANNON ST
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City | MORGANFIELD
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State | KY
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Zip | 42437-1421
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Country | US
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Telephone | 270-952-8905
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 171670
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License Number State | KY
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