Healthcare Provider Details

I. General information

NPI: 1568527281
Provider Name (Legal Business Name): GWENDOLYN MILLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GWEN MILLER LCSW

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 08/30/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 N PECOS ROAD, NORTH LAS VEGAS, NV 89086-4400
NORTH LAS VEGAS NV
89086-4400
US

IV. Provider business mailing address

145 ALAMERE FALLS DR
LAS VEGAS NV
89138-6156
US

V. Phone/Fax

Practice location:
  • Phone: 702-791-9000
  • Fax:
Mailing address:
  • Phone: 312-391-0113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number150009996
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149018026
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: