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NPI Code Detail

MEDICARE: JAMES FITZGERALD MILLS CIT

MEDICARE: JAMES FITZGERALD MILLS CIT
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
1101YA0400XAddiction (Substance Use Disorder) Counselor3139LA

General Provider Information

NPI Number : 1588194336
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES FITZGERALD MILLS CIT
Provider Business Mailing Address
First Line : PO BOX 580
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70602-0580
Country : US
Telephone Number : 337-855-9023
Fax Number : 337-855-1829
Provider Business Practice Location Address
First Line : 21089 SOUTH FRONTAGE RD
Second Line :
City : LACASSINE
State : LA
Zip : 70650
Country : US
Telephone Number : 337-936-9197
Fax Number : 337-855-1829
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2017
Last Update Date : 06/14/2017

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