Healthcare Provider Details

I. General information

NPI: 1457080574
Provider Name (Legal Business Name): LOREN J MILLER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 RODGERS DR
SEARCY AR
72143-7433
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 501-279-7979
  • Fax: 501-305-7433
Mailing address:
  • Phone: 870-347-2534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4967-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: