Provider Demographics
NPI:1447438395
Name:MILNER, TAMMIE DIANE
Entity type:Individual
Prefix:
First Name:TAMMIE
Middle Name:DIANE
Last Name:MILNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 W COUNTRY LAKES ST
Mailing Address - Street 2:
Mailing Address - City:HAYSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67060-5601
Mailing Address - Country:US
Mailing Address - Phone:316-993-6879
Mailing Address - Fax:
Practice Address - Street 1:1931 W COUNTRY LAKES ST
Practice Address - Street 2:
Practice Address - City:HAYSVILLE
Practice Address - State:KS
Practice Address - Zip Code:67060-5601
Practice Address - Country:US
Practice Address - Phone:316-993-6879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-02
Last Update Date:2008-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSTLMLP1045103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling