Healthcare Provider Details

I. General information

NPI: 1801175229
Provider Name (Legal Business Name): BRUCE LEE MILLER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2011
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17571 N DAM ACCESS RD
WARSAW MO
65355-6396
US

IV. Provider business mailing address

305 W MAIN ST
SEDALIA MO
65301-3821
US

V. Phone/Fax

Practice location:
  • Phone: 660-438-2717
  • Fax: 660-438-2313
Mailing address:
  • Phone: 660-310-0909
  • Fax: 888-979-8868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2024049967
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number6885651-3503
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: