Provider Demographics
NPI:1770098949
Name:MILLS, HEATHER MICHELLE
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MICHELLE
Last Name:MILLS
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 1:150 WOODLAND HILLS DR
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:KY
Mailing Address - Zip Code:40734
Mailing Address - Country:US
Mailing Address - Phone:606-627-6029
Mailing Address - Fax:
Practice Address - Street 1:200 DANIEL BOONE DR
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-1104
Practice Address - Country:US
Practice Address - Phone:606-627-6029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY165326103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist