Provider Demographics
NPI:1003521162
Name:MILAM, PATRICK TAYLOR (LMSW)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:TAYLOR
Last Name:MILAM
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:MILAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:1112 STONECREST DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-6548
Mailing Address - Country:US
Mailing Address - Phone:205-834-7135
Mailing Address - Fax:
Practice Address - Street 1:7901 CRESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:IRONDALE
Practice Address - State:AL
Practice Address - Zip Code:35210-2611
Practice Address - Country:US
Practice Address - Phone:205-933-8101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6035G104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL6035GOtherALABAMA BOARD OF SOCIAL WORK EXAMINERS
ORA12396OtherOREGON BOARD OF SOCIAL WORK