Provider Demographics
NPI:1649033440
Name:MILLAN, NAYELY MARIBEL
Entity type:Individual
Prefix:
First Name:NAYELY
Middle Name:MARIBEL
Last Name:MILLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6413 JAYMAR DR NE
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-1095
Mailing Address - Country:US
Mailing Address - Phone:503-569-7183
Mailing Address - Fax:
Practice Address - Street 1:6413 JAYMAR DR NE
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-1095
Practice Address - Country:US
Practice Address - Phone:503-569-7183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR8793101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor