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NPI 1972926558

NPI 1972926558 : DEAH MILLER LMSW, LCAC : WICHITA, KS

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General NPI Number Information
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    NPI Number           |    1972926558
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    Entity Type          |    Individual 
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    Provider Name        |    DEAH MILLER LMSW, LCAC
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    02/02/2014
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    Last Update Date     |    02/02/2014
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Provider Practice Location Address
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    Address Line         |    714 S HILLSIDE ST 
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    City                 |    WICHITA
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    State                |    KS
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    Zip                  |    67211-3002
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    Country              |    US
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    Telephone            |    316-295-4800
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    Fax                  |    316-295-4811
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Provider Business Mailing Address
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    Address Line         |    714 S HILLSIDE ST 
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    City                 |    WICHITA
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    State                |    KS
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    Zip                  |    67211-3002
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    Country              |    US
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    Telephone            |    316-295-4800
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    Fax                  |    316-295-4811
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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        |    101YA0400X
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    Taxonomy Name        |    Addiction (Substance Use Disorder) Counselor
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    License Number       |    058
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    License Number State |    KS
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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       |    6463
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    License Number State |    KS
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