Provider Demographics
NPI:1619621687
Name:MCMILLAN, SANDRA JEAN (MED, LPC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEAN
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:
Other - Last Name:MCMILLAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:604 W WHITE ST STE B
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:TX
Mailing Address - Zip Code:75409-3506
Mailing Address - Country:US
Mailing Address - Phone:972-528-0802
Mailing Address - Fax:
Practice Address - Street 1:604 W WHITE ST STE B
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:TX
Practice Address - Zip Code:75409-3506
Practice Address - Country:US
Practice Address - Phone:972-528-0802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83559101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional