Provider Demographics
NPI:1326767583
Name:LUBIS, MILLA (LCSW)
Entity type:Individual
Prefix:
First Name:MILLA
Middle Name:
Last Name:LUBIS
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6516 S MINERVA AVE APT 2N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-4397
Mailing Address - Country:US
Mailing Address - Phone:630-708-8945
Mailing Address - Fax:
Practice Address - Street 1:2650 W MONTROSE AVE STE 102
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-1562
Practice Address - Country:US
Practice Address - Phone:773-377-5261
Practice Address - Fax:872-813-4596
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0281081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical