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General NPI Number Information
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NPI Number | 1053797613
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Entity Type | Individual
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Provider Name | JEREMY KEITH MILLER MSW, LISW-S,LICDC-CS
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Gender | Male
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Dates
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Enumeration Date | 08/06/2015
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Last Update Date | 11/30/2024
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Provider Practice Location Address
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Address Line | 3401 GLENDALE AVE STE 200
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City | TOLEDO
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State | OH
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Zip | 43614-2490
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Country | US
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Telephone | 567-742-7117
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Fax | 567-200-8410
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Provider Business Mailing Address
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Address Line | 406 DULTON DR
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City | TOLEDO
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State | OH
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Zip | 43615-5109
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Country | US
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Telephone | 567-218-1980
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.1700237-SUPV
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LICDC.161437
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License Number State | OH
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