Individual
MR. MATTHEW DUANE MILLICAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LPC
Contact information
Practice address
123 MCCLURE AVE, NAMPA, ID 83651-2057
(208) 461-3720
Mailing address
1207 SW 2ND AVE, ONTARIO, OR 97914-4512
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-6347
ID
Other
Enumeration date
11/29/2016
Last updated
11/29/2016
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