MEDICARE: MRS. GEORGETTE C. MILLA LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MFC37713	CA

General Provider Information

NPI Number	:	1053458570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GEORGETTE C. MILLA LMFT

Provider Business Mailing Address
First Line	:	1100 W SHAW AVE
Second Line	:	SUITE 112
City	:	FRESNO
State	:	CA
Zip	:	93711-3708
Country	:	US
Telephone Number	:	559-221-8874
Fax Number	:	559-222-5789

Provider Business Practice Location Address
First Line	:	1100 W SHAW AVE
Second Line	:	SUITE 112
City	:	FRESNO
State	:	CA
Zip	:	93711-3708
Country	:	US
Telephone Number	:	559-221-8874
Fax Number	:	559-222-5789

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	07/08/2007

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