Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY7256 | CA |
N | 103G00000X | Clinical Psychologist | PSY7256 | CA |
N | 103TC0700X | Clinical Psychologist | PSY7256 | CA |
NPI | 1568542520 |
---|---|
Provider Name | Dr. Michael Harris Millman |
First Address | Folsom, CA 95630-3886 |
Second Address | Folsom, CA 95630-3886 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00PL72560 | (02) | CA |