Provider Demographics
NPI:1760530471
Name:MCMILLIN, KIM M (RN, LMFT)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:M
Last Name:MCMILLIN
Suffix:
Gender:F
Credentials:RN, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8393
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-0393
Mailing Address - Country:US
Mailing Address - Phone:509-979-4357
Mailing Address - Fax:509-979-4357
Practice Address - Street 1:1402 S GRAND BLVD STE 202
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-5001
Practice Address - Country:US
Practice Address - Phone:509-979-4357
Practice Address - Fax:303-926-0599
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO677106H00000X
WALH60434272101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist