Provider Demographics
NPI:1053458570
Name:MILLA, GEORGETTE C (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:GEORGETTE
Middle Name:C
Last Name:MILLA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W SHAW AVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3708
Mailing Address - Country:US
Mailing Address - Phone:559-221-8874
Mailing Address - Fax:559-222-5789
Practice Address - Street 1:1100 W SHAW AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3708
Practice Address - Country:US
Practice Address - Phone:559-221-8874
Practice Address - Fax:559-222-5789
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37713101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health