Provider Demographics
NPI:1104365543
Name:WORLEY, MILINDA (LLPC)
Entity type:Individual
Prefix:
First Name:MILINDA
Middle Name:
Last Name:WORLEY
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:648 MONROE AVE NW STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-6714
Mailing Address - Country:US
Mailing Address - Phone:616-308-9362
Mailing Address - Fax:
Practice Address - Street 1:648 MONROE AVE NW STE 100
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-6714
Practice Address - Country:US
Practice Address - Phone:616-308-9362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015839101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor