Provider Demographics
NPI:1356912901
Name:MILLER, JENNY LYNN (LAC-BBH-LAC-LIC-4969)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:LYNN
Last Name:MILLER
Suffix:
Gender:F
Credentials:LAC-BBH-LAC-LIC-4969
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 231
Mailing Address - Street 2:
Mailing Address - City:SAINT REGIS
Mailing Address - State:MT
Mailing Address - Zip Code:59866-0231
Mailing Address - Country:US
Mailing Address - Phone:702-358-8629
Mailing Address - Fax:
Practice Address - Street 1:304 4TH AVE E
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:MT
Practice Address - Zip Code:59872-3075
Practice Address - Country:US
Practice Address - Phone:406-822-5422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-49692101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)