MEDICARE: JEROME MILLS 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	104100000X	Social Worker	4004	LA

General Provider Information

NPI Number	:	1841263738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEROME MILLS LCSW

Provider Business Mailing Address
First Line	:	PO BOX 1254
Second Line	:
City	:	BROUSSARD
State	:	LA
Zip	:	70518-1254
Country	:	US
Telephone Number	:	337-837-9837
Fax Number	:	337-837-3616

Provider Business Practice Location Address
First Line	:	403 CHATEAU PL
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-4723
Country	:	US
Telephone Number	:	337-315-3816
Fax Number	:

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

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	07/08/2007

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