Provider Demographics
NPI:1083856736
Name:MARTIN, MILLE JEAN (EDD, LCPC)
Entity Type:Individual
Prefix:DR
First Name:MILLE
Middle Name:JEAN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:EDD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20824 CORINTH ROAD
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1871
Mailing Address - Country:US
Mailing Address - Phone:708-481-5499
Mailing Address - Fax:708-747-1001
Practice Address - Street 1:20824 CORINTH ROAD
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1871
Practice Address - Country:US
Practice Address - Phone:708-481-5499
Practice Address - Fax:708-747-1001
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006612101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health