=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972616829
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBORAH ANN MCMILLIAN MSW, LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 627 N. MORTON ST. SUITE 203
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47404-3778
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-339-9799
-----------------------------------------------------
Fax | 812-339-9799
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 627 N. MORTON ST. SUITE 203
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47404-3778
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-339-9799
-----------------------------------------------------
Fax | 812-339-9799
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 34003928A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------