=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588549034
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAMARA LYNN MILLER MA, NCC, LAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2025
-----------------------------------------------------
Last Update Date | 08/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 758 NJ-18 #110
-----------------------------------------------------
City | EAST BRUNSWICK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-254-0600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 286 S 11TH AVE APT C
-----------------------------------------------------
City | HIGHLAND PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08904-3442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-515-4792
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------