Healthcare Provider Details

I. General information

NPI: 1134004054
Provider Name (Legal Business Name): MILLER MENTAL HEALTH STAFFING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2025
Last Update Date: 11/22/2025
Certification Date: 11/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5190 TWINGING DR
OKEMOS MI
48864-2976
US

IV. Provider business mailing address

4211 OKEMOS RD STE 12
OKEMOS MI
48864-3287
US

V. Phone/Fax

Practice location:
  • Phone: 919-964-5537
  • Fax: 517-201-0607
Mailing address:
  • Phone: 517-214-9779
  • Fax: 517-201-0607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANDREA MILLER
Title or Position: OWNER
Credential: PMHNP
Phone: 517-575-7903