Provider Demographics
NPI:1578609624
Name:HOWELL, MILENA K (PHD, CSC)
Entity Type:Individual
Prefix:DR
First Name:MILENA
Middle Name:K
Last Name:HOWELL
Suffix:
Gender:F
Credentials:PHD, CSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42543 N BACK CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-1240
Mailing Address - Country:US
Mailing Address - Phone:623-551-0986
Mailing Address - Fax:623-551-0985
Practice Address - Street 1:1904 W PARKSIDE LN
Practice Address - Street 2:SUITE 201
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-1228
Practice Address - Country:US
Practice Address - Phone:623-551-0986
Practice Address - Fax:623-551-0985
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3400103T00000X
MI6301008525103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ576035Medicaid
AZZ66331Medicare ID - Type Unspecified
AZ576035Medicaid