Provider Demographics
NPI:1962972349
Name:MCMILLAN BEHAVIORAL HEALTH AND ADDICTION SERVICES PLLC
Entity type:Organization
Organization Name:MCMILLAN BEHAVIORAL HEALTH AND ADDICTION SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-907-0247
Mailing Address - Street 1:800 HILTON RD STE 1
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-2505
Mailing Address - Country:US
Mailing Address - Phone:248-907-0247
Mailing Address - Fax:248-907-0247
Practice Address - Street 1:800 HILTON RD STE 1
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-2505
Practice Address - Country:US
Practice Address - Phone:248-907-0247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-28
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty