Provider Demographics
NPI:1912634320
Name:MILLER, JASON LEE (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:LEE
Last Name:MILLER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 N DEERFIELD CT
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-7986
Mailing Address - Country:US
Mailing Address - Phone:316-706-5157
Mailing Address - Fax:316-358-7713
Practice Address - Street 1:6611 E CENTRAL AVE STE C
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-1937
Practice Address - Country:US
Practice Address - Phone:316-706-5157
Practice Address - Fax:316-358-7140
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMFT03397106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist