Healthcare Provider Details

I. General information

NPI: 1407775711
Provider Name (Legal Business Name): TIMOTHY MILLER LPC, NCC, SAC-IT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 N JEFFERSON ST STE 408
MILWAUKEE WI
53202-3875
US

IV. Provider business mailing address

777 N JEFFERSON ST STE 408
MILWAUKEE WI
53202-3875
US

V. Phone/Fax

Practice location:
  • Phone: 872-205-6953
  • Fax:
Mailing address:
  • Phone: 872-205-6953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12567125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: