Provider Demographics
NPI:1922462217
Name:MCMILLAN, HOWARD (MA)
Entity Type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:
Last Name:MCMILLAN
Suffix:
Gender:M
Credentials:MA
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 52
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL BAY
Mailing Address - State:MN
Mailing Address - Zip Code:55323-0052
Mailing Address - Country:US
Mailing Address - Phone:612-840-8494
Mailing Address - Fax:
Practice Address - Street 1:1275 LYMAN AVE
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-8801
Practice Address - Country:US
Practice Address - Phone:612-840-8494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302762101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)