Provider Demographics
NPI:1710548383
Name:MILLER, LEAH (LPC, LMAC)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPC, LMAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 S HOLLAND ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-2007
Mailing Address - Country:US
Mailing Address - Phone:316-796-5782
Mailing Address - Fax:
Practice Address - Street 1:551 S HOLLAND ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-2007
Practice Address - Country:US
Practice Address - Phone:316-796-5782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMAC34101YA0400X
KSLPC2471101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)