Healthcare Provider Details

I. General information

NPI: 1891471082
Provider Name (Legal Business Name): ALEXIS MILLER MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 RAYBROOK ST SE STE 104C
GRAND RAPIDS MI
49546-7717
US

IV. Provider business mailing address

18 CALEDONIA ST NE
GRAND RAPIDS MI
49505-4902
US

V. Phone/Fax

Practice location:
  • Phone: 616-325-3389
  • Fax:
Mailing address:
  • Phone: 616-916-4847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451023038
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401225360
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: