Provider Demographics
NPI:1346413838
Name:MILLER, MARTIN KONANTZ (LIMHP, LADC)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:KONANTZ
Last Name:MILLER
Suffix:
Gender:M
Credentials:LIMHP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 N SAINT JOSEPH AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-7555
Mailing Address - Country:US
Mailing Address - Phone:402-463-5075
Mailing Address - Fax:402-463-5073
Practice Address - Street 1:225 N SAINT JOSEPH AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-7555
Practice Address - Country:US
Practice Address - Phone:402-463-5075
Practice Address - Fax:402-463-5073
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE701101YA0400X
NE1073101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)