MEDICARE: MILLS PRO COUNSELING LLC

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	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1528837960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLS PRO COUNSELING LLC

Provider Business Mailing Address
First Line	:	94210 HOLDENBURY DR UNIT B
Second Line	:
City	:	FORT DRUM
State	:	NY
Zip	:	13603-3268
Country	:	US
Telephone Number	:	580-373-2820
Fax Number	:	580-547-5242

Provider Business Practice Location Address
First Line	:	94210 HOLDENBURY DR UNIT B
Second Line	:
City	:	FORT DRUM
State	:	NY
Zip	:	13603-3268
Country	:	US
Telephone Number	:	580-373-2820
Fax Number	:	580-547-5242

Authorized Official
Title or Position	:	SOLE PRACTITIONER/OWNER
Name	:	KELLY BETH MILLS
Credential	:	LPC, NCC, CCMHC
Telephone Number	:	580-373-2820

Provider Enumeration Date	:	12/27/2023
Last Update Date	:	07/17/2025

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