Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 1352 | KY |
NPI | 1003125246 |
---|---|
Provider Name | Megan Mcmillen |
First Address | Louisville, KY 40206-1513 |
Second Address | Louisville, KY 40218-1282 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2010 |
Last Update Date | 21/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100254670 | (05) | KY |