Healthcare Provider Details

I. General information

NPI: 1992432058
Provider Name (Legal Business Name): JALYN CORIN MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 N 9TH ST
NOBLESVILLE IN
46060-2236
US

IV. Provider business mailing address

54 N 9TH ST
NOBLESVILLE IN
46060-2236
US

V. Phone/Fax

Practice location:
  • Phone: 317-645-7691
  • Fax:
Mailing address:
  • Phone: 317-645-7691
  • Fax:

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: