Provider Demographics
NPI:1497925168
Name:MILLS, PAMELA KAY (LISW-S)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:KAY
Last Name:MILLS
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12968 HARDIN PIKE
Mailing Address - Street 2:
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-8323
Mailing Address - Country:US
Mailing Address - Phone:419-738-7773
Mailing Address - Fax:
Practice Address - Street 1:12968 HARDIN PIKE
Practice Address - Street 2:
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-8323
Practice Address - Country:US
Practice Address - Phone:419-738-7773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-09
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 08000541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2940250Medicaid