Provider Demographics
NPI:1508230053
Name:MILLER, LORI ANN (LLMSW, DP-C)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:LLMSW, DP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3582 E HOTCHKISS RD
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-5369
Mailing Address - Country:US
Mailing Address - Phone:989-392-8423
Mailing Address - Fax:
Practice Address - Street 1:1420 CENTER AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6110
Practice Address - Country:US
Practice Address - Phone:989-686-1990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-20
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
MI6802088825104100000X
MI6851101085104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator