Provider Demographics
NPI:1750977864
Name:MILLIGAN, MICHAEL S (LCSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:MILLIGAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1176 STARFIRE ST
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3146
Mailing Address - Country:US
Mailing Address - Phone:208-421-7024
Mailing Address - Fax:
Practice Address - Street 1:601 POLE LINE RD
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4085
Practice Address - Country:US
Practice Address - Phone:208-814-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-14
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
IDLCSW-390771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical