Provider Demographics
NPI:1295225308
Name:MILLS, ANGEL N (LPC)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:N
Last Name:MILLS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BIA HWY 27
Mailing Address - Street 2:GENERAL DELIVERY
Mailing Address - City:PORCUPINE
Mailing Address - State:SD
Mailing Address - Zip Code:57772
Mailing Address - Country:US
Mailing Address - Phone:605-646-2469
Mailing Address - Fax:
Practice Address - Street 1:1000 HEALTH CTR RD
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:SD
Practice Address - Zip Code:57752
Practice Address - Country:US
Practice Address - Phone:605-455-8202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMH0192171101YM0800X
OR101YM0800X
SDLPC20628101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500743876Medicaid