Provider Demographics
NPI:1942270285
Name:MILLS, JOHN D (LSW, ASCW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:MILLS
Suffix:
Gender:M
Credentials:LSW, ASCW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3887 OKEMOS RD
Mailing Address - Street 2:SUITE A4
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3664
Mailing Address - Country:US
Mailing Address - Phone:517-381-0111
Mailing Address - Fax:517-381-0444
Practice Address - Street 1:3887 OKEMOS RD
Practice Address - Street 2:SUITE A4
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3664
Practice Address - Country:US
Practice Address - Phone:517-381-0111
Practice Address - Fax:517-381-0444
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010336871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI80OC311530OtherBCBS PROVIDER