Provider Demographics
NPI:1609042332
Name:MCMILLAN, COURTNEY LETHEM (MHPP)
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:LETHEM
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 MACRI VLY
Mailing Address - Street 2:
Mailing Address - City:MOUNT IDA
Mailing Address - State:AR
Mailing Address - Zip Code:71957-9340
Mailing Address - Country:US
Mailing Address - Phone:501-620-6316
Mailing Address - Fax:870-867-4104
Practice Address - Street 1:600 MAIN ST
Practice Address - Street 2:SUITE V
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-4905
Practice Address - Country:US
Practice Address - Phone:501-321-8200
Practice Address - Fax:501-321-8202
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator