Provider Demographics
NPI:1134585490
Name:MILLIKEN, MATTHEW (LMSW)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:MILLIKEN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 WASHTENAW AVE STE 7C
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4525
Mailing Address - Country:US
Mailing Address - Phone:734-234-6931
Mailing Address - Fax:734-203-0600
Practice Address - Street 1:2350 WASHTENAW AVE STE 7C
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4525
Practice Address - Country:US
Practice Address - Phone:734-234-6931
Practice Address - Fax:734-203-0600
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-01
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011040331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical