MEDICARE: MELANIE A MILLER LSCSW LLC

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
1	1041C0700X	Clinical Social Worker	LSCSW2157	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	069800	OTHER	KS	BLUE CROSS BLUE SHIELD OF KANSAS

General Provider Information

NPI Number	:	1255838900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELANIE A MILLER LSCSW LLC

Provider Business Mailing Address
First Line	:	224 E 2ND ST
Second Line	:
City	:	NEWTON
State	:	KS
Zip	:	67114-3404
Country	:	US
Telephone Number	:	316-288-0090
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 N AMIDON AVE STE 207
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67203-2140
Country	:	US
Telephone Number	:	316-288-0090
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST/OWNER
Name	:	MELANIE A. MILLER GARRETT
Credential	:	LSCSW
Telephone Number	:	316-288-0090

Provider Enumeration Date	:	04/10/2018
Last Update Date	:	04/16/2018

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