Provider Demographics
NPI:1467427070
Name:MILLIS, LORI (PHD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:
Last Name:MILLIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 HOMER AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-2039
Mailing Address - Country:US
Mailing Address - Phone:518-798-8280
Mailing Address - Fax:518-743-8686
Practice Address - Street 1:19 HOMER AVE
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-2039
Practice Address - Country:US
Practice Address - Phone:518-798-8280
Practice Address - Fax:518-743-8686
Is Sole Proprietor?:No
Enumeration Date:2006-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014387103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical