Individual
MR. KERRY LEE MILLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
3010 E STATE BLVD, FORT WAYNE, IN 46805-4700
(260) 471-2300
(260) 471-2778
Mailing address
3010 E STATE BLVD, FORT WAYNE, IN 46805-4700
(260) 471-2300
(260) 471-2778
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
99080987A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200250010
—
IN
Enumeration date
08/30/2017
Last updated
08/30/2017
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