Provider Demographics
NPI:1255838900
Name:MELANIE A MILLER LSCSW LLC
Entity Type:Organization
Organization Name:MELANIE A MILLER LSCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLER GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:316-288-0090
Mailing Address - Street 1:224 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-3404
Mailing Address - Country:US
Mailing Address - Phone:316-288-0090
Mailing Address - Fax:
Practice Address - Street 1:1900 N AMIDON AVE STE 207
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-2140
Practice Address - Country:US
Practice Address - Phone:316-288-0090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW21571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS069800OtherBLUE CROSS BLUE SHIELD OF KANSAS