Provider Demographics
NPI:1720020753
Name:MCMILLAN, RUTH C (LCSW)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:C
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:
Other - Last Name:MCMILLAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 13058
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76094-0058
Mailing Address - Country:US
Mailing Address - Phone:817-300-7884
Mailing Address - Fax:
Practice Address - Street 1:1615 W ABRAM ST
Practice Address - Street 2:SUITE 200 J
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-1788
Practice Address - Country:US
Practice Address - Phone:817-469-7211
Practice Address - Fax:817-459-5123
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX308151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX463999OtherVALUE OPTIONS NUMBER
TX0096HVOtherBLUE CROSS BLUE SHIELD
TX609923Medicare ID - Type Unspecified