Provider Demographics
NPI:1902021512
Name:BERNADETTE MULLINS MILLER LLC
Entity Type:Organization
Organization Name:BERNADETTE MULLINS MILLER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLINS-MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MSSW LCSW
Authorized Official - Phone:414-378-0999
Mailing Address - Street 1:2600 N MAYFAIR RD STE 305
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1303
Mailing Address - Country:US
Mailing Address - Phone:414-378-0999
Mailing Address - Fax:414-536-8605
Practice Address - Street 1:2600 N MAYFAIR RD STE 305
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1303
Practice Address - Country:US
Practice Address - Phone:414-378-0999
Practice Address - Fax:414-536-8605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39223700Medicaid
WISUFFIX BOtherHUMANA ID NUMBER
WISUFFIX BOtherHUMANA ID NUMBER
WI39223700Medicaid
WI=========014OtherBLUE CROSS BLUE SHIELD