MEDICARE: KELLY MILLS

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	101YP2500X	Professional Counselor	4068	OK

General Provider Information

NPI Number	:	1245635382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY MILLS

Provider Business Mailing Address
First Line	:	94210 HOLDENBURY DR
Second Line	:	UNIT B
City	:	WATERTOWN
State	:	NY
Zip	:	13603-3268
Country	:	US
Telephone Number	:	580-699-1661
Fax Number	:

Provider Business Practice Location Address
First Line	:	94210 HOLDENBURY DR
Second Line	:	UNIT B
City	:	WATERTOWN
State	:	NY
Zip	:	13603-3268
Country	:	US
Telephone Number	:	580-373-2820
Fax Number	:

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

Provider Enumeration Date	:	10/31/2014
Last Update Date	:	07/25/2025

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Directions to “ KELLY MILLS ” Practice Location

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