Healthcare Provider Details

I. General information

NPI: 1720165731
Provider Name (Legal Business Name): SHEILA KAY MILLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 01/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 CHESTER BLVD
RICHMOND IN
47374-1908
US

IV. Provider business mailing address

645 S ROGERS ST
BLOOMINGTON IN
47403-2353
US

V. Phone/Fax

Practice location:
  • Phone: 765-983-3092
  • Fax: 765-983-3237
Mailing address:
  • Phone: 812-337-2366
  • Fax: 812-337-2438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34004816A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: