Provider Demographics
NPI:1194913194
Name:MILLER, JEAN M (LISW, LCSW)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:LISW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 E. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-1763
Mailing Address - Country:US
Mailing Address - Phone:502-503-0612
Mailing Address - Fax:
Practice Address - Street 1:151 E. MAIN STREET
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-1983
Practice Address - Country:US
Practice Address - Phone:937-293-8300
Practice Address - Fax:937-534-1347
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI11000031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical