Provider Demographics
NPI:1700287810
Name:MILLER, JENNIFER STUART (TLPC-MHSP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:STUART
Last Name:MILLER
Suffix:
Gender:F
Credentials:TLPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 BROTHER BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38133-8950
Mailing Address - Country:US
Mailing Address - Phone:901-251-4986
Mailing Address - Fax:
Practice Address - Street 1:3915 BRISTOL HWY STE 101
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-1400
Practice Address - Country:US
Practice Address - Phone:423-283-6539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3107101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health