Individual
MR. SHAWN MCMILLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LASUDC
Contact information
Practice address
411 N GRANT ST, SALT LAKE CITY, UT 84116-2725
(801) 359-8862
Mailing address
411 N GRANT ST, SALT LAKE CITY, UT 84116-2725
(801) 359-8862
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
312170-6008
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
HT005146-001
—
UT
Enumeration date
06/12/2017
Last updated
07/21/2022
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