Provider Demographics
NPI:1134472863
Name:MILLIGAN, LYNETTE J (MS)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:J
Last Name:MILLIGAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 3913
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97538
Mailing Address - Country:US
Mailing Address - Phone:541-761-0530
Mailing Address - Fax:541-690-1117
Practice Address - Street 1:142 N IVY ST STE 2
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-2758
Practice Address - Country:US
Practice Address - Phone:541-761-0530
Practice Address - Fax:541-690-1117
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORSTB-T-10130007101Y00000X, 101YM0800X, 101YP2500X
ORSTB-T-100130007103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst