MEDICARE: MILLENNIUM MENTAL HEALTH CONCEPTS 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1710844899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLENNIUM MENTAL HEALTH CONCEPTS LLC

Provider Business Mailing Address
First Line	:	30 N GOULD ST STE N
Second Line	:
City	:	SHERIDAN
State	:	WY
Zip	:	82801-6317
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 N GOULD ST
Second Line	:
City	:	SHERIDAN
State	:	WY
Zip	:	82801-6317
Country	:	US
Telephone Number	:	509-768-2249
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	TOBIAS HAMLIN
Credential	:
Telephone Number	:	509-768-2249

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/08/2026

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