Provider Demographics
NPI:1104927425
Name:MINER, MICHELE (LCPC DPEA)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:
Last Name:MINER
Suffix:
Gender:F
Credentials:LCPC DPEA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 E GOLF RD
Mailing Address - Street 2:DR MICHELE MINER SUITE 115
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-4049
Mailing Address - Country:US
Mailing Address - Phone:312-397-0408
Mailing Address - Fax:847-981-0878
Practice Address - Street 1:415 E GOLF RD
Practice Address - Street 2:DR MICHELE MINER SUITE 115
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4049
Practice Address - Country:US
Practice Address - Phone:312-397-0408
Practice Address - Fax:847-981-0878
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No103T00000XBehavioral Health & Social Service ProvidersPsychologist