Healthcare Provider Details

I. General information

NPI: 1992509574
Provider Name (Legal Business Name): JESSICA MILLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

668 HI CREST DR
LEXINGTON KY
40505-2362
US

IV. Provider business mailing address

PO BOX 54332
LEXINGTON KY
40555-4332
US

V. Phone/Fax

Practice location:
  • Phone: 606-341-0358
  • Fax:
Mailing address:
  • Phone: 859-490-7854
  • Fax: 859-399-6877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number260234
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number260234
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: