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General NPI Number Information
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NPI Number | 1679612899
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Entity Type | Individual
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Provider Name | MELODIE COLE MILLER LPC
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Gender | Female
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 111 RACINE ST
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City | MEMPHIS
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State | TN
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Zip | 38111-2707
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Country | US
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Telephone | 901-323-3600
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Fax | 901-323-3640
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Provider Business Mailing Address
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Address Line | 10476 RED STONE DR
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City | COLLIERVILLE
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State | TN
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Zip | 38017-1972
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Country | US
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Telephone | 901-853-2819
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0000001955
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License Number State | TN
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