Healthcare Provider Details

I. General information

NPI: 1083853709
Provider Name (Legal Business Name): JENNIFER LYNNE MILLER M.A., R.N., L.M.H.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2009
Last Update Date: 02/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 W 2ND AVE STE 600
SPOKANE WA
99201-4539
US

IV. Provider business mailing address

906 W 2ND AVE STE 600
SPOKANE WA
99201-4539
US

V. Phone/Fax

Practice location:
  • Phone: 509-458-5889
  • Fax: 509-624-1216
Mailing address:
  • Phone: 509-458-5889
  • Fax: 509-624-1216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60069317
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN00097765
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: