MEDICARE: MARY MILLER

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	2026023175	MO

General Provider Information

NPI Number	:	1740115161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY MILLER

Provider Business Mailing Address
First Line	:	9122 WHITE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63144-1630
Country	:	US
Telephone Number	:	636-577-4449
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 S MERAMEC AVE STE 823T
Second Line	:
City	:	CLAYTON
State	:	MO
Zip	:	63105-3519
Country	:	US
Telephone Number	:	314-328-4361
Fax Number	:

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

Provider Enumeration Date	:	06/16/2026
Last Update Date	:	06/16/2026

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Directions to “ MARY MILLER ” Practice Location

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