Provider Demographics
NPI:1326785965
Name:MILLS, MARK BETHEA (MED, LPC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:BETHEA
Last Name:MILLS
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 ENGLISH VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35223-1729
Mailing Address - Country:US
Mailing Address - Phone:205-746-9428
Mailing Address - Fax:
Practice Address - Street 1:2112 ENGLISH VILLAGE LN
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35223-1729
Practice Address - Country:US
Practice Address - Phone:205-746-9428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-2306101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional