Provider Demographics
NPI:1306015441
Name:MILLER, SUSAN RAE (LCPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:RAE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 HASKELL AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-3249
Mailing Address - Country:US
Mailing Address - Phone:785-422-9922
Mailing Address - Fax:785-422-7499
Practice Address - Street 1:2001 HASKELL AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046-3249
Practice Address - Country:US
Practice Address - Phone:785-422-9922
Practice Address - Fax:785-422-7499
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0199101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional