Provider Demographics
NPI:1033685235
Name:MILLS, LIANA ELISE (AUD)
Entity Type:Individual
Prefix:
First Name:LIANA
Middle Name:ELISE
Last Name:MILLS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:LIANA
Other - Middle Name:ELISE
Other - Last Name:TULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 WILLOW CREEK DR STE 105
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76085-3652
Mailing Address - Country:US
Mailing Address - Phone:817-550-6115
Mailing Address - Fax:
Practice Address - Street 1:150 WILLOW CREEK DR STE 105
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76085
Practice Address - Country:US
Practice Address - Phone:817-550-6115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81106231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist