Provider Demographics
NPI:1366567356
Name:MCMILLAN, HOLLIS LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:HOLLIS
Middle Name:LYNN
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7911 HERSCHEL AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-0075
Mailing Address - Country:US
Mailing Address - Phone:858-459-8538
Mailing Address - Fax:858-459-5885
Practice Address - Street 1:7911 HERSCHEL AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-0075
Practice Address - Country:US
Practice Address - Phone:858-459-8538
Practice Address - Fax:858-459-5885
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 15034101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional