Provider Demographics
NPI:1912285461
Name:MILLER, MELISA J (MS, LPC-1605)
Entity Type:Individual
Prefix:
First Name:MELISA
Middle Name:J
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS, LPC-1605
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 ENERGY CT
Mailing Address - Street 2:SUITE 311
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-5522
Mailing Address - Country:US
Mailing Address - Phone:307-248-6312
Mailing Address - Fax:307-248-4705
Practice Address - Street 1:1901 ENERGY CT
Practice Address - Street 2:SUITE 311
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-5522
Practice Address - Country:US
Practice Address - Phone:307-248-6312
Practice Address - Fax:307-248-4705
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-1605101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional