Provider Demographics
NPI:1740419209
Name:MCMILLIAN, TAMARA LAKEISHA (JD, MSW)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LAKEISHA
Last Name:MCMILLIAN
Suffix:
Gender:F
Credentials:JD, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 LOFTUS CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-2798
Mailing Address - Country:US
Mailing Address - Phone:317-340-8368
Mailing Address - Fax:
Practice Address - Street 1:3302 LOFTUS CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-2798
Practice Address - Country:US
Practice Address - Phone:317-340-8368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical