Healthcare Provider Details

I. General information

NPI: 1245922285
Provider Name (Legal Business Name): JESSICA PIERRETTE MILLER MACMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 PINE ST STE 300
KLAMATH FALLS OR
97601-6020
US

IV. Provider business mailing address

409 PINE ST STE 300
KLAMATH FALLS OR
97601-6020
US

V. Phone/Fax

Practice location:
  • Phone: 541-824-0990
  • Fax: 541-824-0991
Mailing address:
  • Phone: 541-824-0990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberR10539
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR10539
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: