MEDICARE: MRS. DIANNA LYNN MILLER LCPC,CRADC,LMHC,LCAC

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	23238	IL
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	87000115A	IN
3	101YM0800X	Mental Health Counselor	180009026	IN
4	101YM0800X	Mental Health Counselor	39002410A	IN
5	101YP2500X	Professional Counselor	180.009026	IL

General Provider Information

NPI Number	:	1902296387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANNA LYNN MILLER LCPC,CRADC,LMHC,LCAC

Provider Business Mailing Address
First Line	:	200 E CHICAGO AVE STE 30
Second Line	:
City	:	WESTMONT
State	:	IL
Zip	:	60559-1756
Country	:	US
Telephone Number	:	708-769-1374
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 E CHICAGO AVE STE 30
Second Line	:
City	:	WESTMONT
State	:	IL
Zip	:	60559-1756
Country	:	US
Telephone Number	:	630-481-4101
Fax Number	:

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

Provider Enumeration Date	:	01/23/2015
Last Update Date	:	11/15/2024

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