Provider Demographics
NPI:1093124760
Name:MCMILLIAN, KEESHA (LPCC-S)
Entity Type:Individual
Prefix:
First Name:KEESHA
Middle Name:
Last Name:MCMILLIAN
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5241 WILSON MILLS RD
Mailing Address - Street 2:SUITE 24
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2150
Mailing Address - Country:US
Mailing Address - Phone:216-321-1539
Mailing Address - Fax:
Practice Address - Street 1:5241 WILSON MILLS RD
Practice Address - Street 2:SUITE 24
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-2150
Practice Address - Country:US
Practice Address - Phone:216-321-1539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional