Provider Demographics
NPI:1144398322
Name:MILLER, JASON THOMAS (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:THOMAS
Last Name:MILLER
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:5401 COLLEGE BOULEVARD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1617
Mailing Address - Country:US
Mailing Address - Phone:913-636-8566
Mailing Address - Fax:888-515-3097
Practice Address - Street 1:5401 COLLEGE BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1923
Practice Address - Country:US
Practice Address - Phone:913-636-8566
Practice Address - Fax:888-515-3097
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002081101YM0800X
KS4001101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS4001OtherLSCSW
MO1144398322Medicaid
MO002081OtherLCSW