Provider Demographics
NPI:1477767929
Name:MILLER, MELANIE (LSCSW)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:MILLER GARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
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:
Mailing Address - Fax:
Practice Address - Street 1:224 E 2ND ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-3404
Practice Address - Country:US
Practice Address - Phone:316-288-0090
Practice Address - Fax:316-932-1556
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS21571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS069800OtherBLUE CROSS BLUE SHIELD KS
KS069800Medicare ID - Type UnspecifiedMEDICARE ID #