Provider Demographics
NPI:1083961064
Name:MCMILLAN, DARRYN L
Entity type:Individual
Prefix:MR
First Name:DARRYN
Middle Name:L
Last Name:MCMILLAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3568 MASHIE CT
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89413
Mailing Address - Country:US
Mailing Address - Phone:702-524-7120
Mailing Address - Fax:
Practice Address - Street 1:3568 MASHIE CT
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-8525
Practice Address - Country:US
Practice Address - Phone:702-524-7120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst