Healthcare Provider Details

I. General information

NPI: 1619814621
Provider Name (Legal Business Name): RACHEL ALMEDA MILLER MHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4805 BROADWAY ST STE C
MOUNT VERNON IL
62864-6702
US

IV. Provider business mailing address

7250 PARK STREET RD
BENTON IL
62812-4022
US

V. Phone/Fax

Practice location:
  • Phone: 618-288-1133
  • Fax:
Mailing address:
  • Phone: 224-289-7161
  • Fax: 224-289-7161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: