Provider Demographics
NPI:1194369538
Name:MILLER, HEIDI (MA, TLMFT)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA, TLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 1ST AVE SE STE 505
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-3222
Mailing Address - Country:US
Mailing Address - Phone:319-214-0870
Mailing Address - Fax:
Practice Address - Street 1:4403 1ST AVE SE STE 505
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-3222
Practice Address - Country:US
Practice Address - Phone:319-214-0870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
IA119898106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No174H00000XOther Service ProvidersHealth Educator