[4] Forming north of Coos Ridge in the Southern Oregon Coast Range near Ivers Peak, the river flows west, receiving Beulah Creek from the right about 18 miles (29 km) from the mouth.

The river receives Glenn Creek from the right about 7 miles (11 km) from the mouth.

[6][7] The East Fork Millicoma River then passes a stream gauge managed by the Coos Watershed Association.

East Fork Millicoma Road runs parallel to the river for much of its course.

[4][5] The river supports coastal cutthroat trout and a run of winter steelhead.