Provider Demographics
NPI:1982933669
Name:MILLER, RACHAEL L (LCPC, NCC)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 N MARINE DR APT 2911
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1738
Mailing Address - Country:US
Mailing Address - Phone:312-709-0390
Mailing Address - Fax:
Practice Address - Street 1:2950 W CHICAGO AVE STE 202
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-4377
Practice Address - Country:US
Practice Address - Phone:312-709-0390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0900165101YP2500X
IL180008926101YP2500X, 101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341458441Medicaid