Mary Darlene Millicent, LICSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

16030 Issued in MN

Practice address

520 NW 5TH St
Brainerd, MN 56401-2902

Phone

(218) 829-3235

NPI assigned

Nov 21, 2011

Last updated

Nov 21, 2011By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northern Pines Community Mental Health Center

  • Clinical Social Worker
  • Brainerd, MN
  • NPI 1518067750
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1321833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321833600000",
    "number": "1649547589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 1ST ST SE",
            "address_2": "PO BOX 32",
            "city": "RICE",
            "state": "MN",
            "postal_code": "563678857",
            "telephone_number": "320-828-1092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 NW 5TH ST",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564012902",
            "telephone_number": "218-829-3235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLICENT",
        "first_name": "MARY",
        "middle_name": "DARLENE",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-21",
        "last_updated": "2011-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "16030",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NONE-PENDING",
            "identifier": "00000000",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew Michals-Voigt, MS, CRC, LADC, LPCC
• Mille Lacs Band of Ojibwe Indians (Four Winds Lodge)
• Gretchen Miller
• Joel S. Miller, D.D.S.
• Pamela Miller, OTR
• Paul Milloy
• Minnesota Neurorehabilitaion Hospital
• Minnesota Specialty Health Systems-Brainerd
• Minnesota State Colleges and Universities (Central Lakes College)
• Minnesota Teen Challenge, Inc

• Mental Health Counselor in Brainerd, MN
• Providers in Brainerd, MN by specialty
• Mental Health Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.