Provider Demographics
NPI:1649635723
Name:MILLS, DARREN (ND, LMT, CPT)
Entity type:Individual
Prefix:MR
First Name:DARREN
Middle Name:
Last Name:MILLS
Suffix:
Gender:M
Credentials:ND, LMT, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 S HUBBARDS LN STE 98
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3900
Mailing Address - Country:US
Mailing Address - Phone:502-410-1270
Mailing Address - Fax:
Practice Address - Street 1:117 S. HUBBARDS LN. STE. 98
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-410-1270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-16
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYBMTMTH00216698174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator