Provider Demographics
NPI:1518041086
Name:MILLNER, PAUL D (LPCC, LSW)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:D
Last Name:MILLNER
Suffix:
Gender:M
Credentials:LPCC, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 E MAIN AVE
Mailing Address - Street 2:EAP, 2ND FLOOR
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4681
Mailing Address - Country:US
Mailing Address - Phone:701-530-7195
Mailing Address - Fax:701-530-7193
Practice Address - Street 1:1310 E MAIN AVE
Practice Address - Street 2:EAP, 2ND FLOOR
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4681
Practice Address - Country:US
Practice Address - Phone:701-530-7195
Practice Address - Fax:701-530-7193
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND514104100000X
ND188-9-1-91-41101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND514OtherLICENSE
ND20204OtherBCBS