Provider Demographics
NPI:1912169889
Name:MILLHOLLEN, EMILY LOUISE (LCSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:LOUISE
Last Name:MILLHOLLEN
Suffix:
Gender:F
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:PO BOX 1320
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-0152
Mailing Address - Country:US
Mailing Address - Phone:541-600-4744
Mailing Address - Fax:541-615-1477
Practice Address - Street 1:1902 HARBOR DRIVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477
Practice Address - Country:US
Practice Address - Phone:541-600-4744
Practice Address - Fax:541-615-1477
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL72061041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR019047Medicaid