Provider Demographics
NPI:1881600872
Name:MILLS, GARY K (PHD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:K
Last Name:MILLS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 SOSCOL AVE
Mailing Address - Street 2:SUITE 25
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-1351
Mailing Address - Country:US
Mailing Address - Phone:707-963-1493
Mailing Address - Fax:707-963-1463
Practice Address - Street 1:1700 SOSCOL AVE
Practice Address - Street 2:SUITE 25
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-1351
Practice Address - Country:US
Practice Address - Phone:707-963-1493
Practice Address - Fax:707-963-1463
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4876103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY4876OtherLICENSE
CA00PL48760Medicare UPIN