Provider Demographics
NPI:1295054302
Name:MILLEK, LINDA LOU (BS CMT, CHT)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:LOU
Last Name:MILLEK
Suffix:
Gender:F
Credentials:BS CMT, CHT
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:LOU
Other - Last Name:MILLEK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BS, CMT, NBC, CHT
Mailing Address - Street 1:18575 32ND ST
Mailing Address - Street 2:
Mailing Address - City:GOBLES
Mailing Address - State:MI
Mailing Address - Zip Code:49055
Mailing Address - Country:US
Mailing Address - Phone:269-628-0202
Mailing Address - Fax:269-628-0202
Practice Address - Street 1:18575 32ND ST
Practice Address - Street 2:
Practice Address - City:GOBLES
Practice Address - State:MI
Practice Address - Zip Code:49055
Practice Address - Country:US
Practice Address - Phone:269-628-0202
Practice Address - Fax:269-628-0202
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral