Healthcare Provider Details

I. General information

NPI: 1013490101
Provider Name (Legal Business Name): REBECCA MILLER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 ELM ST
BOSCOBEL WI
53805-1216
US

IV. Provider business mailing address

406 ELM ST
BOSCOBEL WI
53805-1216
US

V. Phone/Fax

Practice location:
  • Phone: 608-391-2436
  • Fax:
Mailing address:
  • Phone: 608-391-2436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: REBECCA MILLER
Title or Position: PROVIDER/OWNER
Credential: LPC
Phone: 608-391-2436