Healthcare Provider Details

I. General information

NPI: 1821695172
Provider Name (Legal Business Name): BROOKE MARIE MILLER LPC, R-DMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W VIRGINIA ST STE 204
MILWAUKEE WI
53204-1549
US

IV. Provider business mailing address

3202 N 52ND ST
MILWAUKEE WI
53216-3242
US

V. Phone/Fax

Practice location:
  • Phone: 414-207-4565
  • Fax: 414-348-0206
Mailing address:
  • Phone: 715-892-2852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10789-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code225600000X
TaxonomyDance Therapist
License Number2399
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: