Provider Demographics
NPI:1134946437
Name:MILAH, TAMMY
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:MILAH
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TAMMY
Other - Middle Name:
Other - Last Name:MILAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDS, MFCC
Mailing Address - Street 1:460 W ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-1954
Mailing Address - Country:US
Mailing Address - Phone:812-275-4821
Mailing Address - Fax:
Practice Address - Street 1:460 W ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-1954
Practice Address - Country:US
Practice Address - Phone:812-275-4821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1547430103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool