Provider Demographics
NPI:1396998605
Name:MILLER, MICHAEL S (LPC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:S
Last Name:MILLER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6462 CROSSBROOK LN APT 5
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-7896
Mailing Address - Country:US
Mailing Address - Phone:501-519-2482
Mailing Address - Fax:
Practice Address - Street 1:204 MISSISSIPPI ST S
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-3025
Practice Address - Country:US
Practice Address - Phone:870-208-8499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1412114101YP2500X
183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No183700000XPharmacy Service ProvidersPharmacy Technician