Provider Demographics
NPI:1861040438
Name:MCMILLIAN, RYAN (LMFT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:MCMILLIAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 VANDENBURG RD APT 3311
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1681
Mailing Address - Country:US
Mailing Address - Phone:215-251-8664
Mailing Address - Fax:
Practice Address - Street 1:751 VANDENBURG RD APT 3311
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1681
Practice Address - Country:US
Practice Address - Phone:215-251-8664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF001098106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist