Provider Demographics
NPI:1063821650
Name:MILLIE A. PATERSON, PLLC
Entity Type:Organization
Organization Name:MILLIE A. PATERSON, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MILLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PATERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, CAADC, MBA
Authorized Official - Phone:810-689-4760
Mailing Address - Street 1:3317 BLUE WATER DR
Mailing Address - Street 2:
Mailing Address - City:BURTCHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48059-2505
Mailing Address - Country:US
Mailing Address - Phone:810-689-4760
Mailing Address - Fax:810-958-1295
Practice Address - Street 1:119 E SANILAC RD
Practice Address - Street 2:SUITE 8
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-1184
Practice Address - Country:US
Practice Address - Phone:810-689-4760
Practice Address - Fax:810-958-1295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010599941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI6573Medicare PIN