Provider Demographics
NPI:1477639201
Name:LISSA D. MILLS, INC
Entity type:Organization
Organization Name:LISSA D. MILLS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISSA
Authorized Official - Middle Name:DONELL
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-265-1819
Mailing Address - Street 1:2201 N CENTRAL EXPY
Mailing Address - Street 2:#110
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2754
Mailing Address - Country:US
Mailing Address - Phone:214-265-1819
Mailing Address - Fax:214-373-9530
Practice Address - Street 1:2201 N CENTRAL EXPY
Practice Address - Street 2:#110
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2754
Practice Address - Country:US
Practice Address - Phone:214-265-1819
Practice Address - Fax:214-373-9530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1531022-02Medicaid