Provider Demographics
NPI:1043882889
Name:MILLS, MIKAYLA ELIZABETH
Entity type:Individual
Prefix:MISS
First Name:MIKAYLA
Middle Name:ELIZABETH
Last Name:MILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIKAYLA
Other - Middle Name:
Other - Last Name:POWLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8748 N 90 E
Mailing Address - Street 2:
Mailing Address - City:BURROWS
Mailing Address - State:IN
Mailing Address - Zip Code:46916
Mailing Address - Country:US
Mailing Address - Phone:765-421-2780
Mailing Address - Fax:
Practice Address - Street 1:615 N 18TH ST STE 101
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-3413
Practice Address - Country:US
Practice Address - Phone:765-423-5361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN221700000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist