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General NPI Number Information
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NPI Number | 1770659815
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Entity Type | Individual
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Provider Name | MARY ELLEN MILLER L.P.C.
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Gender | Female
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 702 N BLACKHAWK AVE SUITE205
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City | MADISON
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State | WI
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Zip | 53705-3357
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Country | US
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Telephone | 608-233-3037
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Fax | 608-233-5893
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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 |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2321-125
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2321-125
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License Number State | WI
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