Provider Demographics
NPI:1356307953
Name:MILBOURN, NANCY ANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ANNE
Last Name:MILBOURN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:ANNE
Other - Last Name:MILBOURN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:5019 WOODLAWN DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3627
Mailing Address - Country:US
Mailing Address - Phone:501-681-0567
Mailing Address - Fax:844-274-3173
Practice Address - Street 1:5019 WOODLAWN DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3627
Practice Address - Country:US
Practice Address - Phone:501-681-0567
Practice Address - Fax:844-274-3173
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR494-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR710654723Medicare UPIN