Provider Demographics
NPI:1003125246
Name:MCMILLEN, MEGAN (LPCC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MCMILLEN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 WINTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1513
Mailing Address - Country:US
Mailing Address - Phone:502-551-3872
Mailing Address - Fax:
Practice Address - Street 1:3121 BROOKLAWN CAMPUS DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1282
Practice Address - Country:US
Practice Address - Phone:502-212-8360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-06
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1352101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100254670Medicaid