Provider Demographics
NPI:1346885944
Name:MILLER, LORI MARIE (MA, LMHC)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 RED MAPLE WAY
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-3739
Mailing Address - Country:US
Mailing Address - Phone:850-729-2607
Mailing Address - Fax:
Practice Address - Street 1:186 RED MAPLE WAY
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-3739
Practice Address - Country:US
Practice Address - Phone:850-729-2607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16225101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health