Provider Demographics
NPI:1396866604
Name:MCMILLAN, PATRICIA A (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:A
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:TRISH
Other - Middle Name:
Other - Last Name:MCMILLAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:967 S COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-8389
Mailing Address - Country:US
Mailing Address - Phone:480-827-1748
Mailing Address - Fax:480-827-1748
Practice Address - Street 1:2120 S MCCLINTOCK DR
Practice Address - Street 2:SUITE 105
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-2692
Practice Address - Country:US
Practice Address - Phone:480-804-0326
Practice Address - Fax:480-302-7884
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-26841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ917271Medicaid