Healthcare Provider Details

I. General information

NPI: 1437438116
Provider Name (Legal Business Name): JESSICA RENEE MILLER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2011
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CAROLINE AVE
PIKEVILLE KY
41501-1101
US

IV. Provider business mailing address

111 CAROLINE AVE
PIKEVILLE KY
41501-1101
US

V. Phone/Fax

Practice location:
  • Phone: 606-253-3045
  • Fax: 606-253-3045
Mailing address:
  • Phone: 606-253-3045
  • Fax: 606-253-3045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1316
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: