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NPI Code Detail

MEDICARE: JORDAN K MILLER

MEDICARE: JORDAN K MILLER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1023635281
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN K MILLER
Provider Business Mailing Address
First Line : 5650 LAKE OTIS PKWY APT H173
Second Line :
City : ANCHORAGE
State : AK
Zip : 99507-1783
Country : US
Telephone Number : 614-216-2845
Fax Number :
Provider Business Practice Location Address
First Line : 1709 BRAGAW ST
Second Line :
City : ANCHORAGE
State : AK
Zip : 99508-3436
Country : US
Telephone Number : 907-792-4121
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2020
Last Update Date : 07/02/2020

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