Provider Demographics
NPI:1598055006
Name:MILLARD, MICHAEL EDWARD II (LMFT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:EDWARD
Last Name:MILLARD
Suffix:II
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15406 MERIDIAN E
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-9504
Mailing Address - Country:US
Mailing Address - Phone:425-275-1383
Mailing Address - Fax:253-604-0261
Practice Address - Street 1:15406 MERIDIAN E
Practice Address - Street 2:SUITE 202
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-9504
Practice Address - Country:US
Practice Address - Phone:425-275-1383
Practice Address - Fax:253-604-0261
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60192673106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist