Provider Demographics
NPI:1972616829
Name:MCMILLIAN, DEBORAH ANN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:MCMILLIAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 N. MORTON ST.
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-3778
Mailing Address - Country:US
Mailing Address - Phone:812-339-9799
Mailing Address - Fax:812-339-9799
Practice Address - Street 1:627 N. MORTON ST.
Practice Address - Street 2:SUITE 203
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-3778
Practice Address - Country:US
Practice Address - Phone:812-339-9799
Practice Address - Fax:812-339-9799
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003928A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000215786OtherANTHEM BC/BS