Provider Demographics
NPI:1740532688
Name:MILLWATER CASE MANAGEMENT CONNECTIONS
Entity type:Organization
Organization Name:MILLWATER CASE MANAGEMENT CONNECTIONS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MILLENDER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:903-681-4147
Mailing Address - Street 1:13060 COUNTY ROAD 3520
Mailing Address - Street 2:
Mailing Address - City:BROWNSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75756-2588
Mailing Address - Country:US
Mailing Address - Phone:903-681-4147
Mailing Address - Fax:
Practice Address - Street 1:13060 COUNTY ROAD 3520
Practice Address - Street 2:
Practice Address - City:BROWNSBORO
Practice Address - State:TX
Practice Address - Zip Code:75756-2588
Practice Address - Country:US
Practice Address - Phone:903-681-4147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54629251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management