MEDICARE: MR. JASON MICHAEL MILLER 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	101YP2500X	Professional Counselor	PC008989	PA

General Provider Information

NPI Number	:	1750822938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON MICHAEL MILLER LPC

Provider Business Mailing Address
First Line	:	1043 FOREST DR
Second Line	:
City	:	STROUDSBURG
State	:	PA
Zip	:	18360-1914
Country	:	US
Telephone Number	:	908-566-5635
Fax Number	:

Provider Business Practice Location Address
First Line	:	1043 FOREST DR
Second Line	:
City	:	STROUDSBURG
State	:	PA
Zip	:	18360-1914
Country	:	US
Telephone Number	:	908-566-5635
Fax Number	:

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

Provider Enumeration Date	:	03/20/2017
Last Update Date	:	03/20/2017

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