Provider Demographics
NPI:1043743107
Name:WILRIDGE, MILLERSON
Entity Type:Individual
Prefix:MISS
First Name:MILLERSON
Middle Name:
Last Name:WILRIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 CRANDALL AVE
Mailing Address - Street 2:
Mailing Address - City:RAYNE
Mailing Address - State:LA
Mailing Address - Zip Code:70578-3614
Mailing Address - Country:US
Mailing Address - Phone:337-384-9490
Mailing Address - Fax:
Practice Address - Street 1:504 CRANDALL AVE
Practice Address - Street 2:
Practice Address - City:RAYNE
Practice Address - State:LA
Practice Address - Zip Code:70578-3614
Practice Address - Country:US
Practice Address - Phone:337-384-9490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health