Provider Demographics
NPI:1477677433
Name:MILTICH, AIMEE P (PHD)
Entity Type:Individual
Prefix:DR
First Name:AIMEE
Middle Name:P
Last Name:MILTICH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:AIMEE
Other - Middle Name:
Other - Last Name:LYST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:570 BAKERS BRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067
Mailing Address - Country:US
Mailing Address - Phone:615-290-6668
Mailing Address - Fax:615-794-2883
Practice Address - Street 1:1250 FARROW RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-7116
Practice Address - Country:US
Practice Address - Phone:718-298-4375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2760103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist