Provider Demographics
NPI:1285136028
Name:MILAM, ANN (MED)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:MILAM
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:DALHART
Mailing Address - State:TX
Mailing Address - Zip Code:79022-0004
Mailing Address - Country:US
Mailing Address - Phone:512-818-2005
Mailing Address - Fax:
Practice Address - Street 1:802 W 7TH ST
Practice Address - Street 2:
Practice Address - City:DALHART
Practice Address - State:TX
Practice Address - Zip Code:79022-3308
Practice Address - Country:US
Practice Address - Phone:512-818-2005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72092101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional