Provider Demographics
NPI:1033989751
Name:MILLER, SHAWN JEFFRY (LPC)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:JEFFRY
Last Name:MILLER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 E CHERRY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-5117
Mailing Address - Country:US
Mailing Address - Phone:309-253-0216
Mailing Address - Fax:
Practice Address - Street 1:218 E CHERRY RIDGE RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-5117
Practice Address - Country:US
Practice Address - Phone:309-253-0216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178018604101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional