MEDICARE: DR. JENNIFER LYNN MILLER PSY.D.

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
2	103TC0700X	Clinical Psychologist	3727	NC
3	103TC0700X	Clinical Psychologist	4063	NC

General Provider Information

NPI Number	:	1497904247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER LYNN MILLER PSY.D.

Provider Business Mailing Address
First Line	:	1501 E 7TH ST
Second Line	:	SUITE 7
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2456
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 E 7TH ST
Second Line	:	SUITE 7
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2456
Country	:	US
Telephone Number	:	412-607-8817
Fax Number	:

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

Provider Enumeration Date	:	09/17/2008
Last Update Date	:	12/23/2010

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