Provider Demographics
NPI:1629188792
Name:MILLIKIN, ANN LK (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:LK
Last Name:MILLIKIN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 ACORN WAY
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IL
Mailing Address - Zip Code:62254
Mailing Address - Country:US
Mailing Address - Phone:618-537-6337
Mailing Address - Fax:
Practice Address - Street 1:2016 VADALABENE DR
Practice Address - Street 2:SUITE A
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-6901
Practice Address - Country:US
Practice Address - Phone:618-604-1696
Practice Address - Fax:618-288-0737
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180003680101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional