Provider Demographics
NPI:1750879557
Name:MILLICAN, LINDA RUTH
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:RUTH
Last Name:MILLICAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PATHWAYS GROUP COUNSELING CENTER
Mailing Address - Street 2:5293 S. 31ST STREET, SUITE #137
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502
Mailing Address - Country:US
Mailing Address - Phone:254-228-5830
Mailing Address - Fax:254-598-2537
Practice Address - Street 1:PATHWAYS GROUP COUNSELING CENTER
Practice Address - Street 2:5293 S. 31ST STREET, SUITE #137
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-3575
Practice Address - Country:US
Practice Address - Phone:254-228-5830
Practice Address - Fax:254-598-2537
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional