Provider Demographics
NPI:1982342994
Name:MILLER, AMOS ROBERT (LAC)
Entity Type:Individual
Prefix:
First Name:AMOS
Middle Name:ROBERT
Last Name:MILLER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 HOPE COURT
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-9725
Mailing Address - Country:US
Mailing Address - Phone:765-404-1442
Mailing Address - Fax:
Practice Address - Street 1:2165 HOPE CT
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-9725
Practice Address - Country:US
Practice Address - Phone:765-404-1442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86000062A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)