Provider Demographics
NPI:1982149647
Name:MILLS, KYMBERLI DAWN (MS, QMHP, LPC)
Entity Type:Individual
Prefix:
First Name:KYMBERLI
Middle Name:DAWN
Last Name:MILLS
Suffix:
Gender:F
Credentials:MS, QMHP, LPC
Other - Prefix:
Other - First Name:KYMBERLI
Other - Middle Name:DAWN
Other - Last Name:EREVIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:PO BOX 469
Mailing Address - Street 2:
Mailing Address - City:HEPPNER
Mailing Address - State:OR
Mailing Address - Zip Code:97836-0469
Mailing Address - Country:US
Mailing Address - Phone:541-676-9161
Mailing Address - Fax:541-676-5662
Practice Address - Street 1:104 SW KINKADE RD
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OR
Practice Address - Zip Code:97818
Practice Address - Country:US
Practice Address - Phone:541-481-2911
Practice Address - Fax:541-481-2006
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 174400000X
ORC8045101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No174400000XOther Service ProvidersSpecialist