Provider Demographics
NPI:1447317912
Name:MIILLE, CAROL ANN (LPC)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:MIILLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:MIILLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 1376
Mailing Address - Street 2:SUITE 175
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-1376
Mailing Address - Country:US
Mailing Address - Phone:503-657-9080
Mailing Address - Fax:503-657-9080
Practice Address - Street 1:9136 ST. HELENS ST
Practice Address - Street 2:SUITE 175
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-1376
Practice Address - Country:US
Practice Address - Phone:503-657-9080
Practice Address - Fax:503-675-9080
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC0270101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC0270OtherSTATE LICENSE