Provider Demographics
NPI:1811325194
Name:MILLER, JENNIFER E (LMFT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA,MFT
Mailing Address - Street 1:2514 1/2 WESLEY ST STE 2
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-1754
Mailing Address - Country:US
Mailing Address - Phone:423-529-0385
Mailing Address - Fax:
Practice Address - Street 1:2514 1/2 WESLEY ST STE 2
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-1754
Practice Address - Country:US
Practice Address - Phone:423-529-0385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
TN1606106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist