Provider Demographics
NPI:1295331098
Name:MCMILLAN, MONIQUE MCKAY (LMSW)
Entity type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:MCKAY
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:
Other - Last Name:REUTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:4401 CAMPUS RIDGE DR STE 2000
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6125
Mailing Address - Country:US
Mailing Address - Phone:989-837-9250
Mailing Address - Fax:
Practice Address - Street 1:4401 CAMPUS RIDGE DR STE 2000
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6125
Practice Address - Country:US
Practice Address - Phone:989-837-9250
Practice Address - Fax:989-837-9255
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010857991041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801085799OtherMASTER'S OF SOCIAL WORK LICENSE/CLINICAL LICENSE