Provider Demographics
NPI:1710231287
Name:MILLION, PHILLIP CLAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:CLAY
Last Name:MILLION
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 S AVENUE K
Mailing Address - Street 2:STATION 3
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-7400
Mailing Address - Country:US
Mailing Address - Phone:575-562-2156
Mailing Address - Fax:575-562-2380
Practice Address - Street 1:1500 S AVENUE K
Practice Address - Street 2:STATION 3
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-7400
Practice Address - Country:US
Practice Address - Phone:575-562-2156
Practice Address - Fax:575-562-2380
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM773231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist