Provider Demographics
NPI:1710625793
Name:MILLER, AMANDA M (LMAC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 S PATTIE AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-1719
Mailing Address - Country:US
Mailing Address - Phone:316-400-6863
Mailing Address - Fax:
Practice Address - Street 1:514 N DODGE AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-5905
Practice Address - Country:US
Practice Address - Phone:316-330-3297
Practice Address - Fax:316-358-7549
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01047101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)