Provider Demographics
NPI:1730381906
Name:MILLS, JENNIFER MILLS (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MILLS
Last Name:MILLS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S ROSE ST APT 401
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5231
Mailing Address - Country:US
Mailing Address - Phone:269-330-4695
Mailing Address - Fax:
Practice Address - Street 1:400 S ROSE ST APT 401
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5231
Practice Address - Country:US
Practice Address - Phone:269-330-4695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013510103T00000X
MI6401008906101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OTH000Medicare UPIN