Healthcare Provider Details

I. General information

NPI: 1518697556
Provider Name (Legal Business Name): AMY MILLER LPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 MAIN ST STE 102
CLARION PA
16214-1079
US

IV. Provider business mailing address

327 MAIN ST STE 102
CLARION PA
16214-1079
US

V. Phone/Fax

Practice location:
  • Phone: 814-454-4422
  • Fax:
Mailing address:
  • Phone: 814-454-4422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierPC003715
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMENTAL HEALTH

VIII. Authorized Official

Name: AMY LYNN MILLER
Title or Position: LICENSE PROFESSIONAL COUNSELOR
Credential: MS
Phone: 181-450-4528