Provider Demographics
NPI:1558881995
Name:MILLARD, KATIE ANN (PLMHP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:ANN
Last Name:MILLARD
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 AVENUE L
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-0785
Mailing Address - Country:US
Mailing Address - Phone:402-889-0582
Mailing Address - Fax:
Practice Address - Street 1:5017 LEAVENWORTH ST STE 1
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-1438
Practice Address - Country:US
Practice Address - Phone:712-322-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11140101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health