Individual
LEWIS JOHN MILLSAP III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
655 E MAIN ST, PERU, IN 46970-2662
(765) 472-1931
(765) 472-1945
Mailing address
655 E MAIN ST, PERU, IN 46970-2662
(765) 472-1931
(765) 472-1945
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
00270
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00270
ICAC
IN
Enumeration date
04/09/2008
Last updated
04/09/2008
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