Provider Demographics
NPI:1154093458
Name:MILLER, MADISON (TLMFT)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:TLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 AL WATERHOUSE AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52214-9420
Mailing Address - Country:US
Mailing Address - Phone:319-929-8840
Mailing Address - Fax:
Practice Address - Street 1:1089 LONGFELLOW DR STE C
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-2023
Practice Address - Country:US
Practice Address - Phone:319-224-5997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA107655106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist