Provider Demographics
NPI:1982404687
Name:MILLICAN, JAMIE LYNN (LPC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:MILLICAN
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 NORTHSTAR LN
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-1590
Mailing Address - Country:US
Mailing Address - Phone:972-268-0480
Mailing Address - Fax:
Practice Address - Street 1:610 UPTOWN BLVD STE 4000
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-3534
Practice Address - Country:US
Practice Address - Phone:214-556-0996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91668101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional