Provider Demographics
NPI:1700219318
Name:MILLIEN, ROXANNE L
Entity type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:L
Last Name:MILLIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROXANNE
Other - Middle Name:L
Other - Last Name:CASTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3652 N CEMETERY ROAD
Mailing Address - Street 2:
Mailing Address - City:PINE
Mailing Address - State:AZ
Mailing Address - Zip Code:85544
Mailing Address - Country:US
Mailing Address - Phone:928-242-0773
Mailing Address - Fax:
Practice Address - Street 1:606 N BOBBY JONES DR
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-3403
Practice Address - Country:US
Practice Address - Phone:928-242-0773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4766962385HR2055X, 253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child