Provider Demographics
NPI:1154544708
Name:MILLER, JOSEPH MAYLEN (MSW DCSW LSCSW)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:MAYLEN
Last Name:MILLER
Suffix:
Gender:M
Credentials:MSW DCSW LSCSW
Other - Prefix:MR
Other - First Name:JOE
Other - Middle Name:M
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW DCSW LSCSW
Mailing Address - Street 1:1411 W 4TH ST
Mailing Address - Street 2:FAMILY CONSULTATION SERVICES STE C
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-3300
Mailing Address - Country:US
Mailing Address - Phone:620-251-6967
Mailing Address - Fax:620-251-6967
Practice Address - Street 1:1411 W 4TH ST
Practice Address - Street 2:FAMILY CONSULTATION SERVICES STE C
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-3300
Practice Address - Country:US
Practice Address - Phone:620-251-6967
Practice Address - Fax:620-251-6967
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01641041C0700X
OK16861041C0700X
TX207041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0000011148OtherBCBS
011148Medicare ID - Type Unspecified