Provider Demographics
NPI:1891863668
Name:MILLER, VIVIAN LEA (LMHC)
Entity Type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:LEA
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 1:705 DOUGLAS ST
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101
Mailing Address - Country:US
Mailing Address - Phone:712-255-5414
Mailing Address - Fax:
Practice Address - Street 1:705 DOUGLAS ST
Practice Address - Street 2:SUITE 350
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101
Practice Address - Country:US
Practice Address - Phone:712-255-5414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00718101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA00718OtherLICENSE MENTAL HEALTH COU
IA53096OtherWELLMARK