Provider Demographics
NPI:1316238728
Name:DR MAURICELMLEI MILLERE, DD BMH CPC CC, COUNSELING SERVICES
Entity type:Organization
Organization Name:DR MAURICELMLEI MILLERE, DD BMH CPC CC, COUNSELING SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LEAD PSYCHOTHERAPIST / COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICELMLEI
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLERE
Authorized Official - Suffix:SR
Authorized Official - Credentials:DD BMH, CPC CC
Authorized Official - Phone:501-786-9493
Mailing Address - Street 1:297 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-1733
Mailing Address - Country:US
Mailing Address - Phone:501-786-9493
Mailing Address - Fax:614-376-4370
Practice Address - Street 1:3007 QUINBY DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4757
Practice Address - Country:US
Practice Address - Phone:501-786-9493
Practice Address - Fax:614-376-4370
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. MAURICELMLEI MILLERE, DD BMH, CPC CC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QM0801X261QM0801X
AR261QR0405X261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder