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NPI Code Detail

MEDICARE: KELLY JO MILLER LCSW

MEDICARE: KELLY JO MILLER LCSW
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
11041C0700XClinical Social Worker110218TX

General Provider Information

NPI Number : 1619755469
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY JO MILLER LCSW
Provider Business Mailing Address
First Line : 4444 W MAIN ST
Second Line :
City : LEAGUE CITY
State : TX
Zip : 77573-1737
Country : US
Telephone Number : 409-763-2373
Fax Number : 409-978-2401
Provider Business Practice Location Address
First Line : 4444 W MAIN ST
Second Line :
City : LEAGUE CITY
State : TX
Zip : 77573-1737
Country : US
Telephone Number : 409-763-2373
Fax Number : 409-978-2401
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2023
Last Update Date : 02/05/2026

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