Provider Demographics
NPI:1760792980
Name:MILLER, JESSICA RAE (MA)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:RAE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
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Mailing Address - Street 1:121 S MARTIN L KING BLVD
Mailing Address - Street 2:SUITE 172
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4309
Mailing Address - Country:US
Mailing Address - Phone:702-486-7410
Mailing Address - Fax:702-486-8880
Practice Address - Street 1:121 S MARTIN L KING BLVD
Practice Address - Street 2:SUITE 172
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4309
Practice Address - Country:US
Practice Address - Phone:702-486-7410
Practice Address - Fax:702-486-8880
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health