Provider Demographics
NPI:1508398538
Name:MILLER, JACQUELINE E (MS, LMHP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:E
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11840 NICHOLAS ST STE 101
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4475
Mailing Address - Country:US
Mailing Address - Phone:402-201-5684
Mailing Address - Fax:
Practice Address - Street 1:11840 NICHOLAS ST STE 101
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4475
Practice Address - Country:US
Practice Address - Phone:402-201-5684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1393101YA0400X
NE4937101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)