Provider Demographics
NPI:1568542520
Name:MILLMAN, MICHAEL HARRIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HARRIS
Last Name:MILLMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 CREEKSIDE DR
Mailing Address - Street 2:STE. 240
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3886
Mailing Address - Country:US
Mailing Address - Phone:916-984-9606
Mailing Address - Fax:916-984-9542
Practice Address - Street 1:1580 CREEKSIDE DR
Practice Address - Street 2:STE. 240
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3886
Practice Address - Country:US
Practice Address - Phone:916-984-9606
Practice Address - Fax:916-984-9542
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7256103TA0400X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL72560Medicare UPIN