Provider Demographics
NPI:1437484292
Name:MILLS, KRISTI MICHELLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTI
Middle Name:MICHELLE
Last Name:MILLS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11555 LOS OSOS VALLEY ROAD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405
Mailing Address - Country:US
Mailing Address - Phone:805-704-1530
Mailing Address - Fax:805-406-5378
Practice Address - Street 1:11555 LOS OSOS VALLEY RD
Practice Address - Street 2:SUITE 206
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-6472
Practice Address - Country:US
Practice Address - Phone:805-704-1530
Practice Address - Fax:805-406-5378
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLCS217821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical