Healthcare Provider Details

I. General information

NPI: 1316238728
Provider Name (Legal Business Name): DR MAURICELMLEI MILLERE, DD BMH CPC CC, COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

Provider Other Name: COUNSELING SERVICES

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3007 QUINBY DR
COLUMBUS OH
43232-4757
US

IV. Provider business mailing address

297 S 17TH ST
COLUMBUS OH
43205-1733
US

V. Phone/Fax

Practice location:
  • Phone: 501-786-9493
  • Fax: 614-376-4370
Mailing address:
  • Phone: 501-786-9493
  • Fax: 614-376-4370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number261QR0405X
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number261QM0801X
License Number StateNC

VIII. Authorized Official

Name: DR. MAURICELMLEI MILLERE SR.
Title or Position: LEAD PSYCHOTHERAPIST / COUNSELOR
Credential: DD BMH, CPC CC
Phone: 501-786-9493