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NPI Code Detail

MEDICARE: JENNY MILLER TLSW

MEDICARE: JENNY MILLER TLSW
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) CounselorTL07019559WV

General Provider Information

NPI Number : 1669683421
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNY MILLER TLSW
Provider Business Mailing Address
First Line : 184 HOLIDAY HILLS DR
Second Line :
City : PARKERSBURG
State : WV
Zip : 26104-8006
Country : US
Telephone Number : 304-420-2400
Fax Number : 304-420-0389
Provider Business Practice Location Address
First Line : 184 HOLIDAY HILLS DR
Second Line :
City : PARKERSBURG
State : WV
Zip : 26104-8006
Country : US
Telephone Number : 304-420-2400
Fax Number : 304-420-0389
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2007
Last Update Date : 07/08/2007

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