MEDICARE: MRS. VICKIE C MILLER L.P.C.L.M.F.T.,L.A.C

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	101Y00000X	Counselor	18524	TX
2	101Y00000X	Counselor	2642	LA
3	106H00000X	Marriage & Family Therapist	304	LA
4	101YA0400X	Addiction (Substance Use Disorder) Counselor	974	LA

General Provider Information

NPI Number	:	1922200815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICKIE C MILLER L.P.C.L.M.F.T.,L.A.C

Provider Business Mailing Address
First Line	:	3025 LONE OAK DR
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71118-2453
Country	:	US
Telephone Number	:	318-347-2221
Fax Number	:	318-861-2162

Provider Business Practice Location Address
First Line	:	3018 OLD MINDEN RD STE 1205
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71112-2446
Country	:	US
Telephone Number	:	318-746-5636
Fax Number	:	318-746-5636

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

Provider Enumeration Date	:	06/03/2007
Last Update Date	:	04/10/2019

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