Provider Demographics
NPI:1841282084
Name:MILLS, BETSY (LPC, SAP, CEAP)
Entity type:Individual
Prefix:
First Name:BETSY
Middle Name:
Last Name:MILLS
Suffix:
Gender:F
Credentials:LPC, SAP, CEAP
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:KLAUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHC
Mailing Address - Street 1:179 PIERCE AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2821
Mailing Address - Country:US
Mailing Address - Phone:478-742-1464
Mailing Address - Fax:478-742-1883
Practice Address - Street 1:179 PIERCE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2821
Practice Address - Country:US
Practice Address - Phone:478-742-1464
Practice Address - Fax:478-742-1883
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1819101YP2500X
IN39001504A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA081330869AMedicaid
IN000000341258OtherANTHEM BCBS