Provider Demographics
NPI:1164790747
Name:MILLER, HEATHER RENEE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:RENEE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:HEATHER
Other - Middle Name:RENEE
Other - Last Name:MERSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2079 EDWARD LN E
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:MI
Mailing Address - Zip Code:48074-1925
Mailing Address - Country:US
Mailing Address - Phone:586-202-6820
Mailing Address - Fax:810-600-7935
Practice Address - Street 1:2079 EDWARD LN E
Practice Address - Street 2:
Practice Address - City:KIMBALL
Practice Address - State:MI
Practice Address - Zip Code:48074-1925
Practice Address - Country:US
Practice Address - Phone:586-202-6820
Practice Address - Fax:810-600-7935
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6010811511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical