Provider Demographics
NPI:1689736027
Name:MCMILLAN, MARKI LARUE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARKI
Middle Name:LARUE
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4762
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4762
Mailing Address - Country:US
Mailing Address - Phone:713-798-6850
Mailing Address - Fax:713-798-2740
Practice Address - Street 1:6655 TRAVIS ST
Practice Address - Street 2:SUITE 700
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1312
Practice Address - Country:US
Practice Address - Phone:713-798-5696
Practice Address - Fax:713-798-1144
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX399051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J3899Medicare PIN