Healthcare Provider Details

I. General information

NPI: 1467103523
Provider Name (Legal Business Name): MILLER THERAPEUTIC WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2022
Last Update Date: 01/11/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 GREEN ACRE ROAD
LITITZ PA
17543
US

IV. Provider business mailing address

1002 LITITZ PIKE STE 284
LITITZ PA
17543-9328
US

V. Phone/Fax

Practice location:
  • Phone: 717-454-7197
  • Fax:
Mailing address:
  • Phone: 717-454-7197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MICHELE LYN MILLER
Title or Position: OWNER
Credential: LMFT
Phone: 717-614-7890