Provider Demographics
NPI:1467958108
Name:MILES, JILLIAN LEE
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:LEE
Last Name:MILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 S 25TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-3002
Mailing Address - Country:US
Mailing Address - Phone:402-805-8360
Mailing Address - Fax:
Practice Address - Street 1:617 S 25TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-3002
Practice Address - Country:US
Practice Address - Phone:402-805-8360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor