MEDICARE: MR. JEREMY KEITH MILLER MSW, LISW-S,LICDC-CS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LICDC.161437	OH
2	1041C0700X	Clinical Social Worker	I.1700237-SUPV	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053797613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEREMY KEITH MILLER MSW, LISW-S,LICDC-CS

Provider Business Mailing Address
First Line	:	3401 GLENDALE AVE STE 200
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-2490
Country	:	US
Telephone Number	:	567-218-1980
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 GLENDALE AVE STE 200
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-2490
Country	:	US
Telephone Number	:	567-742-7117
Fax Number	:	567-200-8410

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

Provider Enumeration Date	:	08/06/2015
Last Update Date	:	04/29/2026

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