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NPI Code Detail

MEDICARE: STACY MILLMAN

MEDICARE: STACY MILLMAN
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
1103K00000XBehavior AnalystBH000123PA
2103K00000XBehavior Analyst1-16-22818TN
3103K00000XBehavior Analyst1-16-22818IN

General Provider Information

NPI Number : 1225499841
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY MILLMAN
Provider Business Mailing Address
First Line : 3500 DEPAUW BLVD STE 3070
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-6135
Country : US
Telephone Number : 855-324-0885
Fax Number : 317-520-8200
Provider Business Practice Location Address
First Line : 3771 S A ST
Second Line :
City : RICHMOND
State : IN
Zip : 47374-6053
Country : US
Telephone Number : 765-598-4197
Fax Number : 317-520-8200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2016
Last Update Date : 02/14/2024

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Directions to “ STACY MILLMAN ” Practice Location

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