Provider Demographics
NPI:1730130865
Name:MILLER, JEANETTE LOUISE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:LOUISE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2175 LEXINGTON BLVD
Mailing Address - Street 2:BUILDING 4
Mailing Address - City:WASHINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52353-9100
Mailing Address - Country:US
Mailing Address - Phone:319-653-6161
Mailing Address - Fax:
Practice Address - Street 1:2175 LEXINGTON BLVD
Practice Address - Street 2:BUILDING 4
Practice Address - City:WASHINGTON
Practice Address - State:IA
Practice Address - Zip Code:52353-9100
Practice Address - Country:US
Practice Address - Phone:319-653-6161
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00739101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health