Provider Demographics
NPI:1639235898
Name:MCMILLIAN, TAMMY CROY (PHD, LMSW)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:CROY
Last Name:MCMILLIAN
Suffix:
Gender:F
Credentials:PHD, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOYNE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49712-1535
Mailing Address - Country:US
Mailing Address - Phone:231-582-0553
Mailing Address - Fax:
Practice Address - Street 1:701 S PARK ST
Practice Address - Street 2:
Practice Address - City:BOYNE CITY
Practice Address - State:MI
Practice Address - Zip Code:49712-1535
Practice Address - Country:US
Practice Address - Phone:231-582-0553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010707361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900003358OtherPRIORITY HEALTH VENDOR #