Provider Demographics
NPI:1578072203
Name:MCMILLAN, MEREDITH JANE (LMHC)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:JANE
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-3542
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5421 US HIGHWAY 98 S
Practice Address - Street 2:
Practice Address - City:HIGHLAND CITY
Practice Address - State:FL
Practice Address - Zip Code:33846
Practice Address - Country:US
Practice Address - Phone:863-701-7373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15374101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health