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General NPI Number Information
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NPI Number | 1932809993
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Entity Type | Organization
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Legal Business Name | JEAN MILLER LCSW LLC
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Dates
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Enumeration Date | 03/08/2023
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Last Update Date | 03/08/2023
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Provider Practice Location Address
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Address Line | 117 S 5TH ST
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City | GOSHEN
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State | IN
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Zip | 46528-3711
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Country | US
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Telephone | 574-238-1566
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Fax |
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Provider Business Mailing Address
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Address Line | 117 S 5TH ST
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City | GOSHEN
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State | IN
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Zip | 46528-3711
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Country | US
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Telephone | 574-238-1566
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEAN MILLER
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Credential | LCSW
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Telephone | 574-238-1566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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