MEDICARE: MS. LOUISE L MCMILLAN LCSW

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	1041C0700X	Clinical Social Worker	34003446A	IN

General Provider Information

NPI Number	:	1447205075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LOUISE L MCMILLAN LCSW

Provider Business Mailing Address
First Line	:	202 MYERS RD
Second Line	:
City	:	DANVILLE
State	:	IN
Zip	:	46122-9702
Country	:	US
Telephone Number	:	317-718-8436
Fax Number	:	317-718-8438

Provider Business Practice Location Address
First Line	:	1100 SOUTHFIELD DR
Second Line	:	STE 1205
City	:	PLAINFIELD
State	:	IN
Zip	:	46168-4499
Country	:	US
Telephone Number	:	317-718-8436
Fax Number	:	317-718-8438

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	08/23/2016

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