Provider Demographics
NPI:1679068597
Name:THE MILIEU THERAPEUTIC SERVICES, PC
Entity Type:Organization
Organization Name:THE MILIEU THERAPEUTIC SERVICES, PC
Other - Org Name:TMTSONLINE.COM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLARD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:833-464-5438
Mailing Address - Street 1:5007C VICTORY BLVD # 118
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-5601
Mailing Address - Country:US
Mailing Address - Phone:833-464-5438
Mailing Address - Fax:757-578-8226
Practice Address - Street 1:1730 GEORGE WASHINGTON MEM HWY STE F-6
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-4328
Practice Address - Country:US
Practice Address - Phone:833-464-5438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-23
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC079317721Medicaid
IN30050538Medicaid