Provider Demographics
NPI:1245708882
Name:MILIAN, JESSICA (MG60886656)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MILIAN
Suffix:
Gender:F
Credentials:MG60886656
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:SMARRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31310 36TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-2102
Mailing Address - Country:US
Mailing Address - Phone:360-632-6077
Mailing Address - Fax:
Practice Address - Street 1:6201 PACIFIC AVE STE C3
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-7423
Practice Address - Country:US
Practice Address - Phone:253-363-1453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60886656106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist