MEDICARE: SUSAN MILLER COUNSELING 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1447760558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN MILLER COUNSELING LLC

Provider Business Mailing Address
First Line	:	2001 HASKELL AVE
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66046-3249
Country	:	US
Telephone Number	:	785-542-1300
Fax Number	:	785-841-1094

Provider Business Practice Location Address
First Line	:	2001 HASKELL AVE
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66046-3249
Country	:	US
Telephone Number	:	785-542-1300
Fax Number	:	785-841-1094

Authorized Official
Title or Position	:	COUNSELOR
Name	:	SUSAN RAE MILLER
Credential	:	LCPC
Telephone Number	:	785-542-1300

Provider Enumeration Date	:	10/03/2017
Last Update Date	:	10/13/2017

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