Healthcare Provider Details

I. General information

NPI: 1417783184
Provider Name (Legal Business Name): ALYSON MILLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 CHURCH ST
O FALLON MO
63366-2894
US

IV. Provider business mailing address

105 CHURCH ST
O FALLON MO
63366-2894
US

V. Phone/Fax

Practice location:
  • Phone: 636-294-5787
  • Fax: 636-284-5788
Mailing address:
  • Phone: 636-294-5787
  • Fax: 636-284-5788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2024042086
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: