Provider Demographics
NPI:1386791440
Name:MILLS, BRADLEY JAY (LSCSW)
Entity type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:JAY
Last Name:MILLS
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 E. 9TH ST. SUITE 211
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156
Mailing Address - Country:US
Mailing Address - Phone:620-229-9049
Mailing Address - Fax:316-383-4575
Practice Address - Street 1:103 E. 9TH ST. SUITE 211
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156
Practice Address - Country:US
Practice Address - Phone:620-229-9049
Practice Address - Fax:316-383-4575
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS22651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical