Provider Demographics
NPI:1245581271
Name:MILLER, PATRICIA ANN (LCPC, LMHC, CCMHC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCPC, LMHC, CCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 7TH STREET
Mailing Address - Street 2:STE. E
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265
Mailing Address - Country:US
Mailing Address - Phone:309-764-5040
Mailing Address - Fax:309-764-9001
Practice Address - Street 1:5030 38TH AVE
Practice Address - Street 2:STE. 18
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6717
Practice Address - Country:US
Practice Address - Phone:309-517-1179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001371101YP2500X
SC69996101YP2500X
IL180.006915101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional