=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740471432
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOY MILLER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2007
-----------------------------------------------------
Last Update Date | 10/12/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7617 N VILLA WOOD LN
-----------------------------------------------------
City | PEORIA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61614-1588
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-693-8200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7617 N VILLA WOOD LN
-----------------------------------------------------
City | PEORIA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61614-1588
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-693-8200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOY MILLER
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 309-693-8200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 180000345
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------