Provider Demographics
NPI:1700340817
Name:PERKINS, MILLICENT MARIE (PSYD)
Entity type:Individual
Prefix:
First Name:MILLICENT
Middle Name:MARIE
Last Name:PERKINS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9177 W R AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-9740
Mailing Address - Country:US
Mailing Address - Phone:269-806-5473
Mailing Address - Fax:
Practice Address - Street 1:9177 W R AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-9740
Practice Address - Country:US
Practice Address - Phone:269-806-5473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009903103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical