Healthcare Provider Details

I. General information

NPI: 1962420133
Provider Name (Legal Business Name): TRACY RENEE MILLER L.M.H.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 NW 105TH ST
OCALA FL
34482-1434
US

IV. Provider business mailing address

4055 NW 105TH STREET
OCALA FL
34482-1434
US

V. Phone/Fax

Practice location:
  • Phone: 352-671-2777
  • Fax:
Mailing address:
  • Phone: 352-671-2777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 8425
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: