Provider Demographics
NPI:1972040525
Name:MILLIKAN, JASON ROBERTS (LPCA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ROBERTS
Last Name:MILLIKAN
Suffix:
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 W OBANNON ST
Mailing Address - Street 2:
Mailing Address - City:MORGANFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42437-1421
Mailing Address - Country:US
Mailing Address - Phone:270-952-8905
Mailing Address - Fax:
Practice Address - Street 1:230 2ND ST STE 308
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-3176
Practice Address - Country:US
Practice Address - Phone:270-827-8671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171670101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health