Healthcare Provider Details

I. General information

NPI: 1306382882
Provider Name (Legal Business Name): LORI MILLER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 SE FEDERAL HWY STE D
STUART FL
34994-4531
US

IV. Provider business mailing address

PO BOX 784
PORT SALERNO FL
34992-0784
US

V. Phone/Fax

Practice location:
  • Phone: 772-266-3254
  • Fax:
Mailing address:
  • Phone: 772-266-3254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH18022
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: