Provider Demographics
NPI:1811905136
Name:MILLS, KATHLEEN ANN (MED)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
Last Name:MILLS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14679 MIDWAY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3168
Mailing Address - Country:US
Mailing Address - Phone:972-234-6634
Mailing Address - Fax:972-234-6648
Practice Address - Street 1:14679 MIDWAY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3168
Practice Address - Country:US
Practice Address - Phone:972-234-6634
Practice Address - Fax:972-234-6648
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10631101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional