Provider Demographics
NPI:1558728998
Name:MILLS, KENYA MONIQUE
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:MONIQUE
Last Name:MILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5575 SIMMONS ST
Mailing Address - Street 2:SUITE #1-122
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-9009
Mailing Address - Country:US
Mailing Address - Phone:336-341-1458
Mailing Address - Fax:702-212-0381
Practice Address - Street 1:5575 SIMMONS ST
Practice Address - Street 2:SUITE #1-122
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-9009
Practice Address - Country:US
Practice Address - Phone:323-786-3997
Practice Address - Fax:702-212-0381
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-15
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst