MEDICARE: MRS. REVON MILLER LMHC, 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	101YM0800X	Mental Health Counselor	LPC012981	GA
2	101YM0800X	Mental Health Counselor	MH18863	FL

General Provider Information

NPI Number	:	1467079921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REVON MILLER LMHC, LPC

Provider Business Mailing Address
First Line	:	281 HARRELL MILL RD
Second Line	:
City	:	CLIMAX
State	:	GA
Zip	:	39834-2778
Country	:	US
Telephone Number	:	229-220-5306
Fax Number	:

Provider Business Practice Location Address
First Line	:	281 HARRELL MILL RD
Second Line	:
City	:	CLIMAX
State	:	GA
Zip	:	39834-2778
Country	:	US
Telephone Number	:	229-220-5306
Fax Number	:

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

Provider Enumeration Date	:	07/01/2020
Last Update Date	:	05/20/2023

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