Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 101YP2500X | Professional Counselor | 178016162 | IL |
N | 225400000X | Rehabilitation Practitioner |
NPI | 1043860117 |
---|---|
Provider Name | Kassandra Mcmillan |
First Address | Elgin, IL 60123-6603 |
Second Address | Elgin, IL 60123-6603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2019 |
Last Update Date | 05/10/2020 |