Healthcare Provider Details

I. General information

NPI: 1548097074
Provider Name (Legal Business Name): CARISSA MILLER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 N HIGHWAY 31
AUSTIN IN
47102-1830
US

IV. Provider business mailing address

2818 SANDALWOOD DR
NEW ALBANY IN
47150-9464
US

V. Phone/Fax

Practice location:
  • Phone: 812-697-2107
  • Fax:
Mailing address:
  • Phone: 812-697-2107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARISSA MILLER
Title or Position: SOLE PROPRIETOR
Credential: LCSW
Phone: 812-697-2107