MEDICARE: AYLA MARIAH MARISSA MILLER LMSW, CADC

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	06599-C	NV
2	1041C0700X	Clinical Social Worker	11528-M	NV

General Provider Information

NPI Number	:	1588039481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYLA MARIAH MARISSA MILLER LMSW, CADC

Provider Business Mailing Address
First Line	:	1863 VAN EPPS DR
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89701-4847
Country	:	US
Telephone Number	:	775-297-5630
Fax Number	:

Provider Business Practice Location Address
First Line	:	5540 RENO CORPORATE DR
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89511-2599
Country	:	US
Telephone Number	:	775-480-9760
Fax Number	:

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

Provider Enumeration Date	:	12/04/2015
Last Update Date	:	06/12/2024

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