Healthcare Provider Details

I. General information

NPI: 1245160605
Provider Name (Legal Business Name): PATRICK MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14500 JOHN HUMPHREY DR UNIT 5
ORLAND PARK IL
60462-2816
US

IV. Provider business mailing address

22636 S FARM VIEW RD
NEW LENOX IL
60451-8519
US

V. Phone/Fax

Practice location:
  • Phone: 708-252-3665
  • Fax:
Mailing address:
  • Phone: 708-252-3665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: