Provider Demographics
NPI:1710988621
Name:MILLER, SUSAN R (LMFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 GOSHEN RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46808-1493
Mailing Address - Country:US
Mailing Address - Phone:260-471-3500
Mailing Address - Fax:260-471-4263
Practice Address - Street 1:850 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3163
Practice Address - Country:US
Practice Address - Phone:574-267-7169
Practice Address - Fax:574-269-3995
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001566A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional