Doctor Name: | DR. MILLE JEAN MARTIN |
NPI Number: | 1083856736 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ED.D., LCPC |
License Number: | 180.006612 |
Business Practice Address: | 20824 Corinth Road Olympia Fields, IL - 604611871 |
Business Phone Number: | 7084815499 |
Business Fax Number: | 7087471001 |
Mailing Address: | 20824 Corinth Road, OLYMPIA FIELDS |
State: | IL |
Postal Code: | 604611871 |
Phone Number: | 7084815499 |
Fax Number: | 7087471001 |
NPI Enumeration Date: | 03/27/2009 |
NPI Last Update Date: | 03/27/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 180.006612 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |