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NPI Code Detail

MEDICARE: DR. JEFFREY LYNN MILLER ED.D.

MEDICARE: DR. JEFFREY LYNN MILLER ED.D.
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
1101YA0400XAddiction (Substance Use Disorder) Counselor061047OH
2103K00000XBehavior Analyst00643OH
3103K00000XBehavior Analyst00121OH

General Provider Information

NPI Number : 1053654517
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY LYNN MILLER ED.D.
Provider Business Mailing Address
First Line : 839 AURORA DR
Second Line :
City : VERMILION
State : OH
Zip : 44089-1026
Country : US
Telephone Number : 216-644-9671
Fax Number :
Provider Business Practice Location Address
First Line : 2186 AMBLESIDE DR
Second Line :
City : CLEVELAND
State : OH
Zip : 44106-4620
Country : US
Telephone Number : 216-721-1400
Fax Number : 216-721-5640
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2013
Last Update Date : 04/03/2013

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