Provider Demographics
NPI:1821367616
Name:MILLER, AREATHA GALE (LSW)
Entity type:Individual
Prefix:MS
First Name:AREATHA
Middle Name:GALE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8726 W MILL RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-1838
Mailing Address - Country:US
Mailing Address - Phone:414-353-9250
Mailing Address - Fax:414-353-2095
Practice Address - Street 1:8726 W MILL RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-1838
Practice Address - Country:US
Practice Address - Phone:414-353-9250
Practice Address - Fax:414-353-2095
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2169-120101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1790972461Medicaid