Provider Demographics
NPI:1124808035
Name:MILLETT, COLLEEN ELAINE (CL HYP)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ELAINE
Last Name:MILLETT
Suffix:
Gender:F
Credentials:CL HYP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4303 BRAEMERE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-0683
Mailing Address - Country:US
Mailing Address - Phone:352-777-3055
Mailing Address - Fax:
Practice Address - Street 1:4303 BRAEMERE DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-0683
Practice Address - Country:US
Practice Address - Phone:352-777-3055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL230130101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health