MEDICARE: JENNIFER MILLER MA, LPC

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	101YP2500X	Professional Counselor	LPC12791	AZ

General Provider Information

NPI Number	:	1346616877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MILLER MA, LPC

Provider Business Mailing Address
First Line	:	659 E LA COSTA DR
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85249-6943
Country	:	US
Telephone Number	:	480-223-3739
Fax Number	:

Provider Business Practice Location Address
First Line	:	1655 W CHANDLER BLVD STE 5
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-6284
Country	:	US
Telephone Number	:	480-223-3739
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2015
Last Update Date	:	08/19/2015

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