1356564983 NPI number — MILLS PSYCHOLOGICAL SERVICES, INC.

Table of content: (NPI 1356564983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356564983 NPI number — MILLS PSYCHOLOGICAL SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILLS PSYCHOLOGICAL SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356564983
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
355 N 21ST ST
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
CAMP HILL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17011-3707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-303-0444
Provider Business Mailing Address Fax Number:
717-303-0108

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
355 N 21ST ST
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
CAMP HILL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17011-3707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-303-0444
Provider Business Practice Location Address Fax Number:
717-303-0108
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MILLS
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
CHAMBERS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
717-303-0444

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PS008182L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 467319 . This is a "CBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 61-23547 . This is a "UBH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1175528 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50026450 . This is a "HBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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