MEDICARE: KELSEY MILLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	178022530	IL
2	101YP2500X	Professional Counselor	CP6105-R	NV
3	101YP2500X	Professional Counselor	22379	NC
4	101YP2500X	Professional Counselor	10323	SC

General Provider Information

NPI Number	:	1003524091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY MILLER

Provider Business Mailing Address
First Line	:	585 MILLSTREAM DR
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-3581
Country	:	US
Telephone Number	:	704-981-0062
Fax Number	:

Provider Business Practice Location Address
First Line	:	585 MILLSTREAM DR
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-3581
Country	:	US
Telephone Number	:	859-992-7429
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2022
Last Update Date	:	04/10/2026

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