=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841587607
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CLAUDINE MILLER LPC, CRAADC, CCDP-D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2011
-----------------------------------------------------
Last Update Date | 06/30/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12166 OLD BIG BEND RD STE 210
-----------------------------------------------------
City | KIRKWOOD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63122-6836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-780-8328
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3834 WYOMING ST
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63116-4841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-780-8328
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 2010019253
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------