Provider Demographics
NPI:1639469315
Name:LAUREN MILLER PSYD LLC
Entity Type:Organization
Organization Name:LAUREN MILLER PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:312-475-0505
Mailing Address - Street 1:1 E SUPERIOR ST
Mailing Address - Street 2:STE 300
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2507
Mailing Address - Country:US
Mailing Address - Phone:312-475-0505
Mailing Address - Fax:312-475-0551
Practice Address - Street 1:1 E SUPERIOR ST
Practice Address - Street 2:STE 300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2507
Practice Address - Country:US
Practice Address - Phone:312-475-0505
Practice Address - Fax:312-475-0551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006440103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty