Provider Demographics
NPI:1063708683
Name:MILLER, JODIE R (LPC)
Entity type:Individual
Prefix:MR
First Name:JODIE
Middle Name:R
Last Name:MILLER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11580 PERKINS RD
Mailing Address - Street 2:APT 166
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1838
Mailing Address - Country:US
Mailing Address - Phone:337-250-5579
Mailing Address - Fax:
Practice Address - Street 1:8211 SUMMA AVE
Practice Address - Street 2:SUITE F
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3471
Practice Address - Country:US
Practice Address - Phone:225-761-1970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3292101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional