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General NPI Number Information
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NPI Number | 1518762756
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Entity Type | Organization
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Legal Business Name | MARY ELLEN MILLER, MS, LPC, LLC
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | W10445 STATE ROAD 16 LOT 21
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City | PORTAGE
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State | WI
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Zip | 53901-9488
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Country | US
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Telephone | 608-617-8419
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Fax |
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Provider Business Mailing Address
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Address Line | W10445 STATE ROAD 16 LOT 21
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City | PORTAGE
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State | WI
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Zip | 53901-9488
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Country | US
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Telephone | 608-617-8419
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. MARY ELLEN ELLEN MILLER MS MILLER
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Credential | LPC
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Telephone | 608-617-8419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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License Number State |
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