MEDICARE: DR. SCOTT RICHARD MILLIS PH.D.

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	103G00000X	Clinical Neuropsychologist	6301007792	MI
2	103TC0700X	Clinical Psychologist	6301007792	MI

General Provider Information

NPI Number	:	1225038904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT RICHARD MILLIS PH.D.

Provider Business Mailing Address
First Line	:	261 MACK AVE
Second Line	:	REHABILITATION INSTITUTE OF MICHIGAN, RM 552
City	:	DETROIT
State	:	MI
Zip	:	48201-2417
Country	:	US
Telephone Number	:	313-993-8085
Fax Number	:

Provider Business Practice Location Address
First Line	:	261 MACK AVE
Second Line	:	REHABILITATION INSTITUTE OF MICHIGAN, RM 552
City	:	DETROIT
State	:	MI
Zip	:	48201-2417
Country	:	US
Telephone Number	:	313-993-8085
Fax Number	:

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	09/11/2025

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