Provider Demographics
NPI:1306382882
Name:MILLER, LORI (LMHC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 784
Mailing Address - Street 2:
Mailing Address - City:PORT SALERNO
Mailing Address - State:FL
Mailing Address - Zip Code:34992-0784
Mailing Address - Country:US
Mailing Address - Phone:772-266-3254
Mailing Address - Fax:
Practice Address - Street 1:2440 SE FEDERAL HWY STE D
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4531
Practice Address - Country:US
Practice Address - Phone:772-266-3254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLMH18022101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health