Healthcare Provider Details

I. General information

NPI: 1982545109
Provider Name (Legal Business Name): IMANI MILLER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 LAURIE LN
JACKSON MS
39212-3523
US

IV. Provider business mailing address

307 LAURIE LN
JACKSON MS
39212-3523
US

V. Phone/Fax

Practice location:
  • Phone: 601-260-4651
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3413
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: