Provider Demographics
NPI:1669683421
Name:MILLER, JENNY (TLSW)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:TLSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 HOLIDAY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-8006
Mailing Address - Country:US
Mailing Address - Phone:304-420-2400
Mailing Address - Fax:304-420-0389
Practice Address - Street 1:184 HOLIDAY HILLS DR
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-8006
Practice Address - Country:US
Practice Address - Phone:304-420-2400
Practice Address - Fax:304-420-0389
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVTL07019559101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)