Provider Demographics
NPI:1689762361
Name:MILLSAP, RAYMOND LEE (LMSW)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:LEE
Last Name:MILLSAP
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4610 FISHER RD
Mailing Address - Street 2:
Mailing Address - City:JEDDO
Mailing Address - State:MI
Mailing Address - Zip Code:48032-8513
Mailing Address - Country:US
Mailing Address - Phone:810-327-0084
Mailing Address - Fax:
Practice Address - Street 1:217 E SANILAC RD
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-1383
Practice Address - Country:US
Practice Address - Phone:810-648-9395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL7996771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical