Provider Demographics
NPI:1477614840
Name:MCMILLIAN, DAVID C (LPC, LMFT)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:MCMILLIAN
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 E 70TH ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4925
Mailing Address - Country:US
Mailing Address - Phone:318-227-9002
Mailing Address - Fax:318-227-9025
Practice Address - Street 1:1407 E 70TH ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4925
Practice Address - Country:US
Practice Address - Phone:318-227-9002
Practice Address - Fax:318-227-9025
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1744101YM0800X
LA539106H00000X
TX3919106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist