Basic Information
| Provider Information | |||||||||
| NPI: | 1962972349 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MCMILLAN BEHAVIORAL HEALTH AND ADDICTION SERVICES PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 436 CHANNING ST | ||||||||
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| City: | FERNDALE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482202549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485069626 | ||||||||
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| Practice Location | |||||||||
| Address1: | 25600 WOODWARD AVE STE 215 | ||||||||
| Address2: | |||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480670945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483997447 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2018 | ||||||||
| LastUpdateDate: | 01/08/2019 | ||||||||
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| AuthorizedOfficialLastName: | MCMILLAN | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | FOUNDER, CEO | ||||||||
| AuthorizedOfficialTelephone: | 2485069626 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.