Provider Demographics
NPI:1639370836
Name:MILLS, ASHLEY JOHNSON (MED, LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:ASHLEY
Middle Name:JOHNSON
Last Name:MILLS
Suffix:
Gender:M
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 COUNTY ROAD 513
Mailing Address - Street 2:
Mailing Address - City:RIENZI
Mailing Address - State:MS
Mailing Address - Zip Code:38865-9507
Mailing Address - Country:US
Mailing Address - Phone:662-840-3008
Mailing Address - Fax:662-841-0337
Practice Address - Street 1:252 S VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-5022
Practice Address - Country:US
Practice Address - Phone:662-840-3008
Practice Address - Fax:662-841-0337
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1151103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling