Provider Demographics
NPI:1104813989
Name:MILLS, LEWIS L (MA)
Entity type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:L
Last Name:MILLS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:DR
Other - First Name:LEW
Other - Middle Name:
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:2815 TALBOT ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-3025
Mailing Address - Country:US
Mailing Address - Phone:619-822-2300
Mailing Address - Fax:415-680-1526
Practice Address - Street 1:2815 TALBOT ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-3025
Practice Address - Country:US
Practice Address - Phone:619-822-2300
Practice Address - Fax:415-680-1526
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC22360106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist