Provider Demographics
NPI:1912262965
Name:MCMILLEN, DENA MICHELLE (MS, LPC, QMHP)
Entity Type:Individual
Prefix:MRS
First Name:DENA
Middle Name:MICHELLE
Last Name:MCMILLEN
Suffix:
Gender:F
Credentials:MS, LPC, QMHP
Other - Prefix:
Other - First Name:DENA
Other - Middle Name:MICHELLE
Other - Last Name:BURGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:445 3RD AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-2272
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:445 3RD AVE SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-2272
Practice Address - Country:US
Practice Address - Phone:541-967-3866
Practice Address - Fax:541-928-3020
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2744101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional