Healthcare Provider Details

I. General information

NPI: 1790795367
Provider Name (Legal Business Name): JERRY E MILLER MS, LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 N 10TH ST
HAMILTON MT
59840-2357
US

IV. Provider business mailing address

T-9 FORT MISSOULA
MISSOULA MT
59804-7202
US

V. Phone/Fax

Practice location:
  • Phone: 406-532-9101
  • Fax: 406-363-4498
Mailing address:
  • Phone: 406-532-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number987
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: