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General NPI Number Information
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NPI Number | 1255684551
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Entity Type | Organization
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Legal Business Name | MILLER COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 10/24/2012
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Last Update Date | 06/03/2013
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Provider Practice Location Address
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Address Line | 821 RAYMOND AVE STE 230A
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City | SAINT PAUL
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State | MN
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Zip | 55114-1525
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Country | US
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Telephone | 651-735-6544
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Fax | 651-730-6657
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Provider Business Mailing Address
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Address Line | 1811 WEIR DR STE 190
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City | WOODBURY
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State | MN
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Zip | 55125-2292
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Country | US
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Telephone | 651-738-8561
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Fax | 651-730-6657
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Authorized Official
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Title or Position | OWNER
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Name | NANCY A MILLER
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Credential | LICSW
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Telephone | 612-735-6544
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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 | 18573
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License Number State | MN
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