Provider Demographics
NPI:1295320554
Name:MICHELLE MILLER PROFESSIONAL COUNSELING LLC
Entity type:Organization
Organization Name:MICHELLE MILLER PROFESSIONAL COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LSCSW, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-223-7337
Mailing Address - Street 1:423 N MCLEAN BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-5964
Mailing Address - Country:US
Mailing Address - Phone:316-223-7337
Mailing Address - Fax:
Practice Address - Street 1:423 N MCLEAN BLVD STE 201
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-5964
Practice Address - Country:US
Practice Address - Phone:316-223-7337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-08
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)