MEDICARE: MELISSA MILLER LAC, NCC

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	101Y00000X	Counselor	37AC00454200	NJ

General Provider Information

NPI Number	:	1639745755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA MILLER LAC, NCC

Provider Business Mailing Address
First Line	:	24 PALMER DR
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-2628
Country	:	US
Telephone Number	:	201-446-3422
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 VALLEY RD
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-2073
Country	:	US
Telephone Number	:	201-446-3422
Fax Number	:

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

Provider Enumeration Date	:	05/29/2021
Last Update Date	:	05/29/2021

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