Healthcare Provider Details

I. General information

NPI: 1568893832
Provider Name (Legal Business Name): RONDA MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 S 18TH ST
LAFAYETTE IN
47905-1575
US

IV. Provider business mailing address

202 MYERS RD
DANVILLE IN
46122-9702
US

V. Phone/Fax

Practice location:
  • Phone: 317-718-8436
  • Fax: 317-718-8438
Mailing address:
  • Phone: 317-718-8436
  • Fax: 317-718-8438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87000473A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number85000081A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39002470A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: