Provider Demographics
NPI:1124182548
Name:MILLIRON, JAMES TREVOR (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:TREVOR
Last Name:MILLIRON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 N OCOEE ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-4475
Mailing Address - Country:US
Mailing Address - Phone:423-614-8135
Mailing Address - Fax:
Practice Address - Street 1:1201 MAGNOLIA AVE NE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311
Practice Address - Country:US
Practice Address - Phone:423-481-8394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1016106H00000X
TN2285103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4004612OtherBCBS
TN7820255OtherAETNA
TN621094229OtherMAGELLAN
TN621094229OtherCIGNA