Provider Demographics
NPI:1306905609
Name:MCMILLAN, KATHRYN W (MA, LPC, LMFT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:W
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:MA, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WESTMARK BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-7371
Mailing Address - Country:US
Mailing Address - Phone:337-654-9037
Mailing Address - Fax:337-269-5525
Practice Address - Street 1:105 WESTMARK BLVD STE C
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-7371
Practice Address - Country:US
Practice Address - Phone:337-654-9037
Practice Address - Fax:337-269-5525
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2289101Y00000X
LA111106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA20-5048126OtherTAX ID NUMBER