MEDICARE: EDNA MILLER CADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	00269-C	NV

General Provider Information

NPI Number	:	1780038059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDNA MILLER CADC

Provider Business Mailing Address
First Line	:	841 E SECOND ST
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89701-5254
Country	:	US
Telephone Number	:	775-883-9933
Fax Number	:	775-883-9934

Provider Business Practice Location Address
First Line	:	841 E SECOND ST
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89701-5254
Country	:	US
Telephone Number	:	775-883-9933
Fax Number	:	775-883-9934

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

Provider Enumeration Date	:	04/22/2016
Last Update Date	:	04/22/2016

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