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General NPI Number Information
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NPI Number | 1316238728
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Entity Type | Organization
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Legal Business Name | DR MAURICELMLEI MILLERE, DD BMH CPC CC, COUNSELING SERVICES
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Dates
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Enumeration Date | 04/20/2011
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Last Update Date | 04/20/2011
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Provider Practice Location Address
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Address Line | 3007 QUINBY DR
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City | COLUMBUS
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State | OH
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Zip | 43232-4757
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Country | US
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Telephone | 501-786-9493
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Fax | 614-376-4370
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Provider Business Mailing Address
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Address Line | 297 S 17TH ST
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City | COLUMBUS
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State | OH
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Zip | 43205-1733
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Country | US
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Telephone | 501-786-9493
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Fax | 614-376-4370
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Authorized Official
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Title or Position | LEAD PSYCHOTHERAPIST / COUNSELOR
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Name | DR. MAURICELMLEI MILLERE SR.
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Credential | DD BMH, CPC CC
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Telephone | 501-786-9493
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 261QR0405X
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 261QM0801X
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License Number State | NC
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