Provider Demographics
NPI:1013520683
Name:MCMILLAN, KAREN (LPC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 W RIVER ST
Mailing Address - Street 2:
Mailing Address - City:MOMENCE
Mailing Address - State:IL
Mailing Address - Zip Code:60954-3851
Mailing Address - Country:US
Mailing Address - Phone:815-472-0030
Mailing Address - Fax:
Practice Address - Street 1:525 E NORTH ST STE B
Practice Address - Street 2:
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915-1186
Practice Address - Country:US
Practice Address - Phone:815-933-0667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.016161101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional