Provider Demographics
NPI:1346562261
Name:MILLS, JEAN ELLEN (MA)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:ELLEN
Last Name:MILLS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 ELMWOOD PARK APT 10
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-1124
Mailing Address - Country:US
Mailing Address - Phone:617-774-7017
Mailing Address - Fax:
Practice Address - Street 1:65 ELMWOOD PARK APT 10
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02170-1124
Practice Address - Country:US
Practice Address - Phone:617-774-7017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor