Provider Demographics
NPI:1205365616
Name:MILLS, DAVID EDWIN JR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EDWIN
Last Name:MILLS
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E BRIN ST
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-2938
Mailing Address - Country:US
Mailing Address - Phone:972-551-8845
Mailing Address - Fax:972-551-8087
Practice Address - Street 1:1200 E. BRIN STREET
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75161
Practice Address - Country:US
Practice Address - Phone:972-551-8845
Practice Address - Fax:972-551-8087
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37282103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic